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HomeMy WebLinkAbout2004-229N L Id 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 'W' 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 . - 1 - r 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 , 20049 provide to the Indian River County Risk Management Division a certificate or certificates issued by an insurer or insurers authorized to conduct business in Florida 2 - r that is rated not less than category A- : VII by A. M . Best, subject to approval by Indian River County's risk manager, of the following types and amounts of insurance : ( i ) Commercial General Liability Insurance in an amount not less than $ 1 , 000 , 000 combined single limit for bodily injury and property damage , including coverage for premises/operations , products/completed operations , contractual liability, and independent contractors ; ( ii ) Business Auto Liability Insurance in an amount not less than $ 1 , 000 , 000 per occurrence combined single limit for bodily injury and property damage , including coverage for owned autos and other vehicles , hired autos and other vehicles , non -owned autos and other vehicles ; and ( iii ) Workers ' Compensation and Employer's Liability (current Florida statutory limit) 5 . 6 Insurance Administration . The insurance certificates , evidencing all required insurance coverages shall be fully acceptable to County in both form and content, and shall provide and specify that the related insurance coverage shall not be cancelled without at least thirty (30 ) calendar days prior written notice having been given to the County. In addition , the County may request such other proofs and assurances as it may reasonably require that the insurance is and at all times remains in full force and effect. Recipient agrees that it is the Recipient's sole responsibility to coordinate activities among itself, the County, and the Recipient's insurer(s) so that the insurance certificates are acceptable to and accepted by County within the time limits set forth in this Contract . The County shall be listed as an additional insured on all insurance coverage required by this Contract, except Workers ' Compensation insurance . The Recipient shall , upon ten ( 10 ) days' prior written request from the County, deliver copies to the County, or make copies available for the County's inspection at Recipient's place of business , of any and all insurance policies that are required in this Contract . If the Recipient fails to deliver or make copies of the policies available to the County; fails to obtain replacement insurance or have previous insurance policies reinstated or renewed upon termination or cancellation of existing required coverages ; or fails in any other regard to obtain coverages sufficient to meet the terms and conditions of this Contract, then the County may, at its sole option , terminate this Contract. 5 . 7 Indemnification . The Recipient shall indemnify and save harmless the County, its agents , officials , and employees from and against any and all claims , liabilities , losses , damage , or causes of action which may arise from any misconduct, negligent act, or omissions of the Recipient, its agents , officers , or employees in connection with the performance of this Contract . 5 . 8 Public Records . The Recipient agrees to comply with the provisions of Chapter 119 , Florida Statutes ( Public Records Law) in connection with this Contract . 6 , Termination . This Contract may be terminated by either party, without cause , upon thirty (30 ) days prior written notice to the other party. In addition , the County may terminate this Contract for convenience upon ten ( 10) days prior written notice to the Recipient if the County determines that such termination is in the public interest. 7 . Availability of Funds . The obligations of the County under this Contract are subject to the availability of funds lawfully appropriated for its purpose by the Board of County Commissioners of Indian River County. - 3 - 8 . Standard Terms , This Contract is subject to the standard terms attached hereto as Exhibit C and incorporated herein in its entirety by this reference . IN WITNESS WHEREOF , County and Recipient have entered into this Contract on the date first above written . INDIAN RIVER COUNTY BOARD OF COUNTY COMMISSIONERS r ' By: Caroline D . Ginn , Ch an BCC Approved : Attest : J . K. Barton , Clerk rr , w :r d By. R Deputy Clea :� ,� `" y •p _ , � . PATRICIA 4 11 Approved : Jos ph A. Baird County Administrator Ap v d as to form and legal sufficiency: r ` J` i ell , Ass istantzg6fity &Attorh4 RECIPIENT : By: s & Girls Club of Indian River County, Inc - 4 - EXHIBIT A [Copy of complete proposal/application] - 1 - EXHIBIT B [From policy adopted by Indian River County Board Of County Commissioners on February 19 , 2002] " D . Nonprofit Agency Responsibilities After Award of Funding Indian River County provides funding to all nonprofit agencies on a reimbursement basis only. All reimbursable expenses must be documented by an invoice and/or a copy of the canceled check . Any expense not documented properly to the satisfaction of the Office of Management & Budget and/or the County Administrator may not be reimbursed . If an agency repeatedly fails to provide adequate documentation , this may be reported to the Board of Commissioners . In the event an agency provides inadequate documentation on a consistent basis , funding may be discontinued immediately. Additionally, this may adversely affect future funding requests . Expenditures may only be reimbursed from the fiscal year for which funding was awarded . For example , no expenditures prior to October 1St may be reimbursed with funds from the following year. Additionally, if any funds are unexpended at the end of a fiscal year, these funds are not carried over to the next year unless expressly authorized by the Board of Commissioners . All requests for reimbursement at fiscal year end (September 30th) must be submitted on a timely basis . Each year, the Office of Management & Budget will send a letter to all nonprofit agencies advising of the deadline for reimbursement requests for the fiscal year. This deadline is typically early to mid October, since the Finance Department does not process checks for the prior fiscal year beyond that point . Each reimbursement request must include a summary of expenses by type . These summaries should be broken down into salaries , benefits , supplies , contractual services , etc. If Indian River County is reimbursing an agency for only a portion of an expense (e . g . salary of an employee ) , then the method for this portion should be disclosed on the summary. The Office of Management & Budget has summary forms available . Indian River County will not reimburse certain types of expenditures . These expenditure types are listed below . a . Travel expenses for travel outside the County including but not limited to ; mileage reimbursement, hotel rooms , meals , meal allowances , per Diem , and tolls . Mileage reimbursement for local travel (within Indian River County) is allowable . b . Sick or Vacation payments for employees . Since agencies may have various sick and vacation pay policies , these must be provided from other sources . c. Any expenses not associated with the provision of the program for which the County has awarded funding . d . Any expense not outlined in the agency's funding application . The County reserves the right to decline reimbursement for any expense as deemed necessary." - 1 - EXHIBIT C STANDARD TERMS FOR GRANT CONTRACT 1 . Notices : Any notice , request, demand , consent , approval or other communication required or permitted by this Contract shall be given or made in writing , by any of the following methods : facsimile transmission ; hand delivery to the other party; delivery by commercial overnight courier service ; or mailed by registered or certified mail (postage prepaid ) , return receipt requested at the addresses of the parties shown below: County: Joyce Johnston-Carlson , Director Indian River County Human Services 1840 25t' Street Vero Beach , Florida 32960-3365 Recipient : Boys & Girls Club of 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 - • ACORD CERTIFICATE OF LIABILITY INSURANCEDATE (MM/DD/YYYY) Tu 10108/2004 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Day Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 11320 SE Federal Hwy. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Hobe Sound FL 33455 7724464767 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' POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION DATE IMMIDDNYI DATE (MM/DDIYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 11000,000 A X COMMERCIAL GENERAL LIABILITY 8502CY2201284 09/13/04 09113105 DAMAGE TO RENTED $ 100 000 CLAIMS MADE FX OCCUR MED EXP (Any oneperson) $ 51000 PERSONAL & ADV INJURY $ 11000, 000 GENERAL AGGREGATE $ 3,000, 000 GEN'LAGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OPAGG $ 1 ,000, 000 X POLICY M PRO- 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 X NON-OWNED AUTOS (Per accident) $ PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO EA ACC $ OTHER THAN AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR FICLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND WC STATLIMIU- OTH- EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E. L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? E .L. DISEASE - EA EMPLOYE $ If yes, tlescribe under SPECIAL PROVISIONS below E. L. DISEASE - POLICY LIMIT $ 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 Indian River County SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Board of County Commissioners DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN 1840 25th St NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL Vero Beach, FL 32960.3365 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE <AJD> ACORD 25 (2001108 ) CORD CORPORATION 1988 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 (2001 /08) 11102 / 2UU4 bb : 4b t6l2yy3b4rJ buYS 61RLS k:Wb IRC PAGE 02 2004 WED 05114 RM WM. DAY , INC . FAX NU. 772 546 5772 r , uo . F o Rett era -- - pelfisurw, rttrr 'lru ',. . , i:��f:; : ;i, tl', " Fid ' $urMrat . lr. , l 'I .N, m� n. Saftt'd�• ('rIr ! t Ciwsr( : Sa►,kbt, ti'Ity 014gi ?'aim {: r \ r NNw41AL ^bu-r: ' ' ? '.< ) liGc 'Jii + ► i .dkClllri1, 11. 3 ,g2 •174K1 +s'K'tt'.Sp !UUt81ilditill'7�. rIM1 Tk>;u}A "t. K: k, • 1, 1Arin44 ! irl ,•ltiH'bt�` l�Ri ) fntififit<:1 <U l •' l�t�•2R2.76�5 • i0K ( KV ) 6Z- 1r1S`i { 1 •Jh,tK. wru �i , .4. du ,nilr ••'• . :;+I r4r � �� .�.. - . .MFT - �� �rw . W w.+� .�—ice rY .�...0 1 c a ef lrnsrranca RE : 0520- 25554 iSSOED TO : Indian River County Board of county Commissioners 1840 25th St Vero Beach, FL 32960 . 3365 c i . tc ccr:ify that Bpy, , Fx � IrJs Gsl,t1ft . R►ver_CO3U Y,1ar,�P - 9•-il3px 305$.1fCto. P�! �5�. irk 329.yg , ub;j �4i to the provisions of the Florida Workers' Compansatlon i.aw, has securad the payment of eny s: Cr 'kers ' compensation benefits due by Insuring their risk with the Florida Retail Federation Sclf Insurers Fund '• Oi- C NUMBER ; 0$ r ? Statutory Limits- • 5tatb of Florida Employers LiabilitY :VE DATE : pl.emlier , l3 , .Z004 $ 500, 000 , ( Each Accident) 1500, 000 ; ( Disease- - Each Employee) -_ X `" ' RA ION DATA ; Se(�ZCILIt?�'r'_1 �200 $ 500 ,000 ' ( Dlseaae -- Policy Limit ) certificate Is not a policy and of itself does not afford any insurancle . Nothing c0rltaine6 in this be construed as amending , extending , or altering coverage not afforded by the poliey Shawn rte; ^ ; i � g insurance to any insured not named above . - ^ %y of insurance listed above has been issued to Che named lnswred for the policy period ind ?cated. any requirement, term or condition of any contract or other doatment to which this cartif! cato available by the described policy in this r; ertain , tile insurance made s certificate Is subject to only the cr - s, exclusbns and conditions of st0 policy , Paid claims may have redtrced the shown limits , eolicy described dbovo is cancelled before the expiration date indicated , the issuing company will r oc 34 days' wrlttcn notice to the certificrata holder named ebbve, although if cancall4L is for of premium , than the isxuing company will attempt to mail ib days' written notice to the r,.Fr `icate noldor , In any event, the issuing company, its agents, and repl'esentatives accept no obligation or ; rs5i ; iry of any kind for failure to mail such notice. , Date 11 / 0312004 C-w val i .^.g ► Ire . . ,�.M71ih1 � txdCCk Ret # 0 'Federation tell InAetiXert A'urd i • � 1 1 1 • 1 1 i x• ! .'�� 1 !', . � • i� . ��� � .,, er., -� • .r • ..,.x na 4r.v f a� III Pill • 1 i • • • • - • • • • • • • • • • • • • • • • - • • • o • ' • • • MIA ji� • ' ' ' • ' 1 1 1 1 i - ,... . { • • . • � • - • R- 1 1 . 1 ., r .rt +° w.�Tt`� 1 Y , c-• rrr � R• � , 1 - 1 1 1 1 1 < � r. � 'F..-�• � k cY • 1 1 1 � ', 1 1 1 1 • • • • . • • • • 1 W41 =qLVMVALwMh-]LOJ • • • 1 1 vein 0 ' • • • • 1 1 > Y t i .M R1 �$yv` �S+ sa. �� "�+ �''` ,ft�`,liH?�"4".'�r : ,S'g�, "�� >• F.r . n u. 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Y5, s.4kM4:+rt,« S3•YryT?S Z$ i r5t ! 1-`I`.. . d a! ?. :t'„4 " �. '> . L1^S"y{A ' , si4; �rfiwe„:Jter9r.. . ?,..n''�% $mR. s�f ,7';d.Z,''Jay. . �Gk�}.,«y..,,:k.', �Mux. �..4�.<•;aT,F'n,x.,'i.�.", q, , �hF , ” + 1 : . ;1, s! ✓ rT; ( v.t�,.j a1S'`e - 'kie .. (y; ,{" 'Y..(? tir � yyY� . , i, ?� v' ^ i " h . . S,+il`.. . k�:tP'av rs rpt",' . f'ry% j:: n 1T.✓«, rVc3 rx "F ^' is Y' ^'-"� yr+ E - „' y` r ' v `� . , a.P � 2} . . .,'a• ,nF r Mh,. p' _ virb �'.;n Boys & Girls Club of Indian River County, Inc. — South County Branch Grant Application to the Children 's Services Advisory Committee PROPOSAL NARRATIVE A. ORGANIZATION CAPABILITY (Entire Section A not to exceed one page) 1 . Provide the mission statement and vision of your organization . Mission Statement : To inspire and enable all young people, especially those from disadvantaged 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 J 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 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 . . KK 1 . 4 ":�+'� b ., f ♦ .t - 4 r [ d ' �. r e+a . i`v`y% ' r+.: I. t) pl F .P �YT� R w #M' W r i� N�+•4t 'v i Y }. Idt l jy Boys & Girls Club of Indian River County, Inc. — South County 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 South County Branch, located at 683 27th Avenue S . W. , or attend Thompson Elementary, Highlands Elementary, Oslo Middle and Vero Beach High School . d) According to the Indian River County School District 63 % of children attending Thompson Elementary School qualify for free and reduced lunches and Thompson Elementary, Oslo Middle and Vero Beach High School are all considered " C" rated schools based on the Florida Comprehensive Assessment Test (FLAT) 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 , W • 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 , +rt fj jld rC ;ryh x iia 2• r 4 T e e . f rk' ' r Boys & Girls Club of Indian River County, Inc. — South County Branch Grant Application to the Children 's Services Advisory Committee C. PROGRAM DESCRIPTION (Entire Section C, I — 6, not to exceed two pages) 1 . List Priority Needs area addressed . Mental Wellness Issues & Childcare Access 2 . Briefly describe program activities including location of services . 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 South County Branch located at 683 27th Avenue, 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 • 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 y survey revealed the firm conviction on the part of alumni thatClub membership had a ositive effect on their lives, provided the skills necessary for leadership, improved their t + 4 l 'kw in i fit. rM,.rr n , » 'two -,f } + x # �cer ya a P ; f Boys & Girls Club of Indian River County, Inc. — South County Branch Grant Application to the Children 's Services Advisory Committee relationships with others and influenced success in later life . • The Carnegie Corporation's report, A Matter of Time: Risk and Opportunity in the Non-School Hours, underscores the importance of community environment and institutions in contributing to the development of young people. The report emphasizes that the opportunity to make a positive contribution arises largely outside the structural academic environment. The report concludes that community-based youth development organizations such as Boys & Girls Clubs represent a valuable national resource with considerable untapped potential , 4. List staffing needed for your program , including required experience and estimated hours per week in program for each staff member and/or volunteers (This section should conform with the information in the Position Listing on the Budget Narrative Worksheet) . 1 full time Director of 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 South County 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 South County 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 South County Branch . 3 part-time Program Specialists — with High School Diplomas, working towards college �Jl degrees, and demonstrated capability in working with youth . Each position dedicates 100 percent 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 South County Branch will distribute flyers throughout Thompson Elementary, Oslo Middle School and Vero Beach High School to promote involvement in the Club program . Word of mouth from members 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 , transpof tation , hours of operation) ? The location of the South County 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 Thompson Elementary and Oslo Middle School 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 . 4. t 'K�`'" r P' �y 111 (r 1s- Ste,` a :r � A ♦ bST P x Y Boys & Girls Club of Indian River County, Inc. — South County Branch 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 for the Measurable Outcomes T. Add the tasks to accom lish the Outcome s1 . To increase average daily attendance ofDistribute Membership Recruitment FlyersSouth County Branch club members by 4in the schools to announce after school (from 60- 85 ) 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 diversity among Club members ages 6- 18 . 2 . To decrease juvenile crime rates of enrolled • Provide daily diversion activities at the 10 - 17 year old Club Members to less than Club to channel the energy of our members . 3 % compared to non-club members which is into a positive direction. To initially spark 10 % as reported by the 2001 -2002 juvenile members ' interests, game room arrests . Baseline : 2001 -2002 Indian River tournaments and outdoor playground County statistics from the FL Department of activities will be offered . After a rapport is Juvenile Justice Bureau Data. ( 10 % of all established, staff will encourage 10- 17 year olds) referred to the juvenile participation in the five, core programs . justice system . • Nominate eligible, deserving 14 year olds for Youth of the 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 that will be 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 . w. Qd # 'k. d? `.• 6 S„ � .'Si ^3x4 `p" ': � _ . Boys & Girls Club of Indian River County, Inc. — South County Branch Grant Application to the Children 's Services Advisory Committee • Implement a Child Safety & Protection Program that meets once a week for 8 weeks . • Implement a violence prevention program that meets once a week for 12 weeks in collaboration with Safe Space . • Implement an anger management and conflict resolution program that meets once a week for 8 weeks in collaboration with Safe Space. 3 . Increase/improve grade and skill levels of . Provide daily Homework Help, Reading & no less than 25 % of Club members Math skills enhancement activities, One- participating in the South County Branch On-One and Group Tutoring, POWER Power Hour program by June 30, 2005 . Pages and POWER Point activities during Baseline : Is' quarter school grades the school year. `" compared to 4quarter grades . . Celebrate improvement in school performance with quarterly parties. Meet with school officials to identify those members who are failing and provide additional homework and tutoring support. • Implement a peer leader homework and tutoring program 5 days a week during the school year. • Establish a Goals for Graduation program that meets once 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 I d Ioffered during the summer. • Create a Career Launch program that will be offered year round to teenagers accessing the web at the Boys & Girls Club . • Provide daily access to computers to improve technology competency levels . Provide daily access to the Advance Learning Systems software in order to improve FCAT competencies , 4 . Maintain 100 % parent involvement of Club Establish a Family Support program, members in the South County Branch ( 195) designed to provide seasonal activities, as reported by the 2004-2005 Parent events and services to strengthen family attendance at Club events . Baseline : 2003 - relations through informal social support. 2004 Parents attendance at Club . . Implement a Family Advisory Network (FAN Club) that will meet 4 times a year. • Survey parents annually to evaluate program uali and identi new areas for service. 1 Aft t�` 4b 2b •A . o-3 l l M. �Y 4 i + ka :t •..413 HS is (� � _ S A ..+� l gill, yH nty , t 5 •-r. b , .. 1 .d .-L: w ri ix. x� r r Boys & Girls Club of Indian River County, Inc. — South County Branch Grant Application to the Children 's Services Advisory Committee E . COLLABORATION (Entire Section E not to exceed one page) 1 . List your program ' s collaborative partners and the resources they are providing to the program beyond referrals and support. (See individual funder requirements for inclusion of collaborative agreement letters .) Collaborative Agency Resources provided to the program Transportation after school from Thompson Elementary Indian River County School District and Oslo Middle 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 . 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. 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'"fid,*': . .t: �T # � -,xa ” #�„� *. ^5p�A � . ..+ � e• Y, '# ( � txi 2,• i4�i.'}' �,' rn r^` P" S � r in. zt .�f:Y�` r���r?� ;.�.� a �C, "' ,rr l �> yy y 'k �J :is.�y � � w, nt ,,,;yY`f� .Y. +� rl'v'u _. �yyx 24 � M .� ac.bs � �'r:,� 1� F I?�` �4 a �: W {5 '",:. u� 3r a . ,. v�YI,,h A ;{^ fi•"j�i , aye. , d.... "5:.�{. :+ r£`,;u : a 3.t 4 h a,6, � -s� .', ti .$. '.. (i' �, . . , Y , ,. ,5 .. • ' ^ „ s t +.,;tb r r .. � e s 1J'1Y3�s �'2 ;�+. `r'r' � <� :r, � '� n "Y`i1 � �s � i`e Y'B 'S" t3+ M .y - `G ,e r a, .. r ryN. , o ; :t . .Y , }%'S a t„fr,� . ;`� 'Nqa sn.r; z R�r1 is ',? f5 ✓`� H✓�`ay'° ° r � ' t r'u# ..a } r t �;'K{s' 'S'e: .0 e .j �. . . • IN • Boys & Girls Clubs of Indian River County, Inc. - South County Branch Grant Application to the Children's Services Advisory Committee UNIFORM GRANT APPLICATION BUDGET NARRATIVE WORKSHEET IMPORTANT: The Budget Narrative should provide details to justify the amount requested in each line item of the budget for your program. From this worksheet, your figures will be linked to the Total Agency Budget, Total Program Budget and Funder Specific Budget Forms. AGENCY/PROGRAM NAME : Boys & Girls Clubs of Indian River County, Inc ./South County Branch FUNDER : Children 's Services Advisory Committee ,I CAUTION : Do not enter any figures where a cell is colored in dark blue - Formulas and/or links are in place. Gray areas should j be used for calculations and to write information only, x t k`� t + a ?,fRy GRAY AREAS FOR a ,'- �l s .- ' IPAGENcyustbrNw `PrO gpd,TO CO ram. r� a b ,` sYm RE,VENUES � p !' g Funders ectfic . I¢ryOW DET)\Ilb E y d"k. ' * Y ' ^` p . " TofafAgencwf cA�cuurloN$ Bt/d e "�� �` , k = B dot k a , _ : 1 1 Children 's Services Council-St. Lucie 2 Children's Services Council-Martin tiAENI' 3 Advisory Committee-Indian River ; . ; 3000000 E 3. 30, 000. 00 4 United Way130,000.00 -St. Lucie County ra , 5 United Way-Martin County :yx 6 United Way-Indian River County 45 ,000.00 7 Department of Children & Families 159,000.00 8 County Funds 9 Contributions -Cash 10 Program Fees 2239000.00 200.00 300. 00 and Raising Events-Net 131 ,692.00 t es to Public - Net � - 200.00 200. 00 13` embership Duesg -` 4 ,200. 00 14 Investment Income 10,050.00 15 Miscellaneous 16 Legacies & Bequests IMA" 17 Funds from Other Sources 28, 333 . 33 18 Reserve Funds Used for Operating 75 ,000.00 hSvx- .�i 19 In -Kin I Donations (Not Included in total) 2016,635. 00 TOTAL REVENUES � v 78 , 540.00 (doesn 't Include line 19) ;h �� $ 107 , 933. 33 $ 30 , 000 : 00 $729,242. 00 k ri,n s4 # C�'S1t�i+X ,, 5 '' c S `,n' y xx MCI � '! s - y EXPENDIT(�RES � 'M VIsgs orr„es �Dq� �Propos1 oaP o ram, rn agr�Cx� AGE c g - Funders ecrfrc o . 21 Salaries - (must completechart onne paw .t HocA EUw(ioW$I D�tl et:. � A , , TotalAgy ' _ ... g . . .H �. P1 ., " 71 < r 9e) 79J 1800 271000. 00 472 , 174 00 ''` - 22 FICrrrr A - �E7;65b/o 5 , 128. 00 2 , 065. 50 - e firemen - nnua pension or qua I Ie F 26, 872.00 23 staff 1 e ea - e Ica en a o -term 0 . 00 33,403. 00 * 1c 24 Disab. 8 ,317. 00 or ers ompensatlon - emp oyees x t t� 934 . 50 32, 574 . 00 25 rate �o # ` 11797. 00 0 . 00 9,415 . 00 n a unemployment - ;; projected e � - , 26 employees x $7, 000 x UCT-6 rate 635 . 00 " 0 . 00 2, 801 .00 el JEL L T( y�+qgpr� Gr ss {Ari uat +. � Sz "�x 4 t h , nay Boys 8 Girls Clubs of Indian River County, Inc. - South County Branch Grant Application to the Children's Services Advisory Committee Director of Club Operations/40 hrs 50 000 . 00 12 , 500.00 Branch Director/40 hrs 27 , 000 . 00 0. 00 0.00% program Director/40 hrs 27,000 .00 27 , 000. 00 100. 00% 25 , 000. 00 25 , 000.00 0.00 0.00% mmer Program Specialist/40 hrs 2l534 .00 AmeriCorps Team Leader/32 hrs 6 042 . 00 2 , 534 . 00 0 .00 0.00% AmeriCorps Team Leader/32 his; 6 042 .00 6 , 042 . 00 0.00 0.00% ' 6, 042 . 00 0.00 0.00°/ #DIV/0! #DIV/ol #DIV/0t #DIV/01 #DIV/01 #DIV/01 #DIV/0I #DIV/01 #DIV/01 #DIV/01 #DIV/01 #DIV/01 #DIV/01 Remaining positions throughout agency 355 , 556. 00MEMEMEMEM #DIV/01 It Total Salaries $472tl74.001 $7911118.00 $27, 000. 00 5.72% FRINGE BENEFITS DETAIL , (FunclerSpeclfic,Budget, y k n� � F: r 4 � : � Gy ; aa. p z- t. `a,,•. .n- � t� Cbfurri» C bn/y, from„%ine 22to 27 : ` s ' SPeCrl ensron F/CA 7 65 a - ealth Inst tNorkeYs Unemptb`yme Notal Frrnges Funder' r „ ra 'Butl a '°I Com ens ntCom anis z ) r = Position Tiffe / Total Nrs/wk F r Example: `Case Manager74t)" hrs ' " p 5'OQO 00 382 5000: 00 500 00 300. 00 200.00 ectorofClubO Operations/40 (,58250 . 00 0.00 0.00 rich Director/40 his; 27,000. 00 2 ,065.50 934 . 50 Program Director/40 hrs 3 , 000.00 0. 00 0 .00 0 . 0 Summer Program Specialist/40 hrs 0. 00 0.00 AmeriCorps Team Leader/32 his; 0 . 0 0.00 0.00 0. 0 AmeriCorps Team Leader/32 hrs 0.00 0.00 0 0.00 0.00 0 . 0 0 0. 000 . 00 0 0.00 0. 00 0.00 0.00 0.00 0 0.00 0.00 0 , : .: 0. 00 0.0 : 0.00 0 0.00 0. 00 0.00 0 0.00 0.00 0 0.00 0.00 0.00 0.00 0.0 0 0 .00 0.00 i 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 0.00 0.0 0 0.00 0.00 0 . 00 P!ToMtalFunder Request Fringe Benefits $271,000 .00 $2 , 065 . 501 $0 .00 V9-34 . 501 $ 0 . 001 $ 0. 00 $311000 . 0 *� x al. s :-:a r � t�u,w,.`« �"a�.x��� �,i'"�ra+ 't i 3,k P� �4f'�A� ' #����� ���° s � ° +"``C ,;'� � .�'��5�. �i �.,� '''Z Pxn��*•',.;� 'A,` tm w aa` a sa8t q,s ua '�m a't a + ask 14T' a3.-x '` � -�. NDI U ES EXPE �� s � pN p'os '': 7ofal_ Prcfg7a " E u Funcleta5pet ►frc7�o' A er`i ' �. ��001 . Pd�Ndy S"t$TNL TQ �- BCI�fJ ri g � . . . ,a1. w a ,, H4kv°e r $Gf a �d� . . . 27 T vel-Dail _ 9�e-` , y - 946 .00 ` - 0.00 58938. 00 tall x average # of miles/wk x 50 wks x - Estimated Daily Travel/Mileage Reimb, e a . . . : . _ . 28 Travel/Conferences/Training 3,750 00 0.00 ? 15,630.00 � "����• at t+"r .. ` S� �Y. , $p, s 3�'YF`� '' eP +' x t '� �wy,�`Yt ) .R t.`aY M r � '' �Yva. : st.t. " ,�. 1y x ,� �4/2�4'� 9 •i ,ep .. ,, . r_ .+ t �.' y y� N rx , , y�{'tC'' e �, � awi41�.'a7 • '� ta` ry" a Boys & Girls Clubs of Indian River County, Inc. - South County Branch Grant Application to the Children's Services Advisory Committee National Conference (cost per sta uve spena .o r, 1 • Training/Seminar (cost per x r P k i W � h 8r5adxn employe& s, • Other Trainings (cost of travel, lodging , g istration , food ) fralnln'g'� ,�.�p s§ i~�, < u `€'" fi � a"x�tx-d�� �"'ro r � '� � f4 ' •* Office Supplies ; ,, pp 967 000 00 6,455 00 Office supplies (monthly average x 12 3 months = estimated cost of office supplies 8 ` � MW `14 80 5ltdrithry �, . . ��� �:R nt based on present history. avers a X12 ` � t ' � " ' 30 Telephone 9 x€ ; " . . >, � .. O �sI � r � 20820 .00 0 00 120 )60.001 # Phone lines x average cost per month x s z : �� s ffiifi 12 months = local phone cost . • Average long distance calls x 12 months ,���`� mllneSy�l01'1g'' Estimated cost of long distance distance 31 Postage/Shipping ,. , x • Quarterly Mailing of Newsletter °� 0 00 a o . 00 1 169 00 SRI • Special events , etc. r �= �� � � � '� ° 4 Bulk mailings - appeals 9 pP 32 Utilities , � 8 300 00 • Electricity ($ x 12 months) �534/m` E eetric° 0 00 161, 500.00 • Water/Sewer ($ x 12 months ) $401rtiWaer "� y, x + � � �$ `hyx+k r«+� .€m + ,... r�i . w # aIn , ik t`�7? r „Fir a e ' + • Garbage ($ x 12 months) Garbage Plekup M �� � � � _ .... . . , . ter§ €.�. 4' _ .. I. - W 33 Occupancy (Building & Grounds) 25 , 745. 00 Mortgage/Rent ($ x 12 months) $ 1960lr>i Rent + 0 00 9311028 .001 $JDIm'"'- . : nc ' +ux £ � � a.:y fear Janitorial ($ x 12 months) _ �'" �w 4 d=''' »t ;-. x- 'wa €` ...gE .IN x>x. � 'x' ' .`: '�`r µlm a y,.t Grounds Maint. ($ x 12 months) Jbanatona 1� , � #. �k 2. .. �� Rea( EstateTaxes , Maintenanc tea. ; � r � , ,, I ,. tt�.' ", L ,..'r K -Efx, 'A .. ' .. . r,ar . .a �.:.Po;r ,,.= f. a . x _» d ' ° f :. 34 Printing & Publications . `" ��'�'�` 1 , 750 00 % Quarter) Newsletter $ x 4 A share of the , 0.00 14,700.00 Y ( ) orgamzatton`s t <� .. ri ° ' a � Letterheads, Envelopes etc. p int ng Td .,, Fundraising materials Bit ided drertie ` - then scription/Dues/Memberships u 1 200 00 • Membership to National Organization 0 0 5 �'y .�., 0 9 83 00 3 Y A ^"' 9" "y._ *" 'rv7 ) Yl S 'SF 'E ', '' y `{'Y M rod ks } .� 3 �,.a f 2 • Dues ° x w x R ^ ��� y } r � ah ax x Subscriptions to Newspapers/magazines, BGA Du&sL ' 4 {a . . Area AIIISnGe f "€x• F'" � d „v S ..,q '�j' , t; "` , ,s �f c x r :.z � a Te x etc. ry : , A 4 'tx,4 .o�4a .. fl �� T � �d �" ky:' •* .43°s_ e' ae # € ! .x�� £ u 36 Insurance 0 00 19,016.00 • Directors/Officers Llab. - , �� "�?. °+^ ; „ gy`n w $ . ;� . { • Commercial/Generallnsurance � Bond Ins. . r . . Aquto; Memb'�e ��„ � � _ � �,�. , � =" .r �� t Auto' Insurance Insurance " A a =� sax .na ° 3t .a :' .� {"W' s��� kr `, x'r -� 9` ii A, 37 Equipment: Rental & Maintenance Copier lease ($ x 12 months) 0 00 7t525 . 00 • Meter lease ($ x 12 months) Copier Maintenance ($, x 12 months e � Computer Maintenance ( $ x 12 months) I ease/ stn e a )1 "(' "rR= • Other r - - ,'`•ms's'' y ti . � c � � 'k ' f 4 � 'f€x � � 38 Advertising . .: • 250 00 0 00 11,300. 00 Newspaper ads z, �h ;' E , Fundraising ads/promotions /� Other (vacancies) b ecrutttn 39 Equipment Purchases : Capital Expense i � s 0 .00 000 000 • Compute rinitor (# X $) � 'a rt rs d • Laser Printer ��� � � �� � . mt 40 Professional Fees ( Legal, Consulting ) xo 0 00 0.00 0 00 • Legal advice ( estimated #hrs x $) • Consultant fees • Other w 41 ,, S/Educational Materials I 4,308 .00 0. 00 12,345.00 r` 0 ks/videos , ��,,. <. s � . � _ Materials ($ x staff) 42 Food & Nutrition-I Tq ;�Zi�-W it • � �, k0. ' 100 00 0 00 �,a � 200 00 t 4/2004 w u ¢ 17 6 w y m y,. r f ?mac,[ d 4✓- .1;,- ♦� �F r 'q t Boys & Girls Clubs of Indian River County, Inc. - South County Branch Grant Application to the Children's Services Advisory Committee Meals ( # meals x clients x 5days x 50 Wks) , Snacks a & y i s 8 It, Citi Srlabftf5rtgram � � No �" revIt Iit IN dministrative Costs r = xZv - IN1r, III fi +fir 0.00 Admin . Cost (% of total budget) 0 00 0 00 �. . Audit Expense r , t . > � 1. Qfvfded oeC att 1 ,750 00 0 00 71000.00 • Independent Audit Review FII IF ' I:% - r "' stRr x r .. 45 Specific Assistance to Individuals '° a � ' • Medical � } assistance _ 0.00 0.00 0,00 MF'N FM1�3 N [JiY+.+Y'f• q4' .2aiyL ° ZIN a F K . . • Meals/Food � �;� � t r tia i s t � ;p s { k . s x e.y ,,, r'Xx zye r r . ,Y W .I ` N. c.•� y, vY, • Rent Assistance , ' s a �" ' s z �, „ ` xA S �. f" c}.may Other 9a' ckMn x ' t ` rIN � s a wx 4 'are y ..IN s . 46 Other/Miscellaneous 837 00 M BarrorjndR ' 0 00 7 842 00 Background check/drug test x�y� { + chIbCKsl drug x z s ° hY f a a c Other a` r�zs s� 47 Other/Contract serde- ri . at�Wl � . ;+ x , ' � � ? � c 0. 00 Sub-contract for program services 00 0.00 PI WAN. M p 0 48 TOTAL EXPENSES - }° $ 160,420.00 $30, 000. 00 $ 807,782. 00 i 4 i Ii 0.,.. 61 It IN INNT ro � SMF J7r 7s'a'1 " t M+ �, s fiiI If r` N'^ a - of 7r 54 '?:ry .._ fife H 4:• .aW�.Sr'et..� IN s ... ..rc , 412 I c x PIN ,004 s a u e I Iry Ift �ek. At a CK68 of Inchn Rinr C�*, Mc, swh cwwr ennch UNIFORM GRANT APPLICATION TOTAL AGENCY BUDGET AGENCY/PROGRAM NAME : Bos & Girls Clubs of Indian River County, Inc./South Coun Branch FY 02/03 F 03/04 FY 04106 % INCREASE FYE June 30 FYE June 30 FYE June 30 CURRENT VS. NEXT FY BUDGET A B C D ACTUAL TOTAL PROPOSED (COLCtoi. BWeol. B REVENUES BUDGETED BUDGETED t 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 90 012.48100 000.00 130 000.00 30.00% 4 United Way-St. Lucie County0.00 0.00 0.00 #DIVl01 5 United Way-Martin County 0.00 0 0.00 #DIVI 0. 0 s United Way-Indian River County136 000.08 126 000.00 159 000.00 26. 19% 7 Department of Children & Families 0.00 0.00 0.00 #DIV/01 a County Funds ' 0. 00 0.00 0.00 #DIV/01 s 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 RaisingEvents-Net 116 345.20 85 500.00 131 692.00 54.03% 12 Sales to Public-Net 1 , 193.51 400.00 200.00 -50.00% 13 Membership Dues 10 142. 00 16 050.00 10 050.00 37.38% 14 Investment Income 876. 69 0.00 0.00 #DIV/01 15 Miscellaneous 71269. 16 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 7500000 -38 .72% 1s Reserve Funds Used for Orwating 0.000.00 0.00 #DIVl01 19 In-Kind Donations (Noe Included In total) 35 382.73 1200000 78 540.00 554.50% 20 TOTAL 688L954 25 673 646.00 729 242 0 00 8.25;/. EXPENDITURES 21 Salaries 334 095.40 379 567. 00 472 174. 00 24.40% 22 FICA 23 880.04 28p720.00 2687200 -6.43% 23 Retirement 81998. 92 21 500.00 3340300 55.36% 24 Life/Health 21 061 . 11 28 114.00 32 574.00 15 .86% 25 Workers Com ensation 10 693 .84 10 323.00 9415.00 -8.80% 26 Florida Unemployment 31042.84 31591 .00 2 801 .00 -22.00% 27 Travel-Dail 2 004.94 500000 51938 .00 18.76% 28 Travel/Conferences/Training17 614. 90 15 630.00 15 630. 00 0.00% 29 Office Supplies 91851 .32 817200 61455. 00 -21 .01 % 30 Telephone 12 246. 96 11 462.00 12 060.00 5.22°/, 31 Postage/Shipping 31462, 12 69960.00 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 .0093 028.00 11 .26°/, 34 Printing- & Publications 31 055.97 13 700.00 14 70000 7.30% 35 Subscription/Dues/Memberships 15 866. 19 10 115.00 9 .835.00 2.77% 36 Insurance 14 914.04 14 763.00 19 016.00 28.81 % 37 Equipment: Rental & Maintenance 2.495.45 6 900.00 7t525. 00 9.06% 36 Advertising ItO91 . 261 11200.00 1 300.00 8.33% 39 Equipment Purchases : Ca ital Expense 11449.77 0.00 0.00 #DIV/01 40 Professional Fees (Legal, Consulting) 275 .00 0.0001 . .00 #DIV/01 41 Books/Educational Materials 6 664.45 9 645 . 00 12345.00 27.99% 42 Food & Nutrition 407.88 600. 00 200.00 -66. 67% 43 Administrative Costs 0.00 0.00 0.00 #DIV/Ol 44 Audit Expense 8p825 .001 71000.00 700000 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 18.39% 47 Other/Contract 0.00 0. 00 0.00 #DIV/Ol 48 TOTAL 653 717 88 685 646 00 807 782 00 17. 81 % . ,.F ° 49 REVENUES OVER/ UNDER EXPENDITURES 35t236.371 -12, 000.00 -78, 540.00 554. 50% Iq If . . If . t ,�Y 9' ^�s � ct ♦ - [ 2 . 3��• z!k�.� "'3.IrR''{a 9 u �,, u3 a,11 n 9. � : r .�� � 3 fi 91 kII �y9 - • FY 02/03 FY 04/05 BUDGETEDFYE June 30 FYE June 30 TOTAL ROPOSED REVENUES BUDGETED ' rrr rrr rrr • • r ' - rrr rrr ■ rrr • • r Advisoryr rrr rr r rrr rr rrr • , ' ' rrr rrr rrr • • r - ' rrr rrr rrr - • • r ' _. • rrr it r rrr rr , rrr rr r • , r - ' ' • rrr — r rr rrr • • r , Countyrrr rrr rrr • r Contributions-Cash rrr — rrr rrr • r , Program _� rr rr rr rr rrr ' zy Sales rr rrr — rrr • r to —®� rr rr rr rr Membership • r : rr rr rr fillInvestment Income rr r rr rrr rrr • r of rrFunds from rrr rrr • r - qU r rr rrr ' rrr • r - • r r r ��- • - • • • - rrr rrr rrr • • r • . rrr rr • r II • r r . r rr r • r . rr rr — • rrr rrr - r rr r • r � ' . . rr rr EXPENDITURES Retirement • • • • rrr . r rr rr �� Florida Unemploymentrrr rr � rr r ` , Travel-Daily : r r rr rr rr Travel/ConferencesfTraining rrr — rrr . rrr • . Office Suppliesr : rr rr ' Telephone © rrr rrr r Postage/Shippinrrr rrr rrr � • r • rr , rr rr _ • . . . rr rr rr � Printing & Publications • •;filmrr rr r r r • • • • rr rr rr rr rr rr . 'Advertising : : — rrr rrr rrr • - . • • • - �� rrr r rr - • r r ' HMO EMSrrr rrr rrr • r Books/Educational — r rr r rrfilm • • ' & Nutritionrr rr rr rr ' rrr rrr rrr • r ' ' - �� rrr rrr rrr • : ' Specific Assistance to Individualsrrr rrr rrr • r Other/Miscellaneous : r rr rr FellifTwen, rrr rrr rrr • r • �� rr . . r rrr • • • r r rr 4 sA�r`�y r x a x ,y. 0 Ke' x4, � ' , � x U a��`r `�" .w"r`"�"'�= .• a °�rt} :�i'fK!� � 7 f�•t�'9* ' .di• � * Wit` '�:'�� ' ¢f '.y} i`5"`4; i'4.. V v ?p 3 •i Rp' S's9 a'..E W ;xe w 'xrDr � , .. {* ..w . *yM \ µ '3 v+Fr. .r� ' : 4tl 't a r ^t* xr:X Y` ' ' s. " A V AW d f��rt 24 F'"w ., r.t^ i ' • 7F11 {� ?�,. 4 :- 'bi� �ie,£ 'a',"7f• eYnflk" : . t ? iRR ^r ••�. - ..; P �'K'.•=. <:';� k � s + k e # ? ,4t.�` y. # C'j- ` ,dM'. : ' ✓,•. ? ^LS. i+k �+ -.-0, m x w,�.r ^ .x$yrt' kf a ia .e. misfiki ` ' Z t .+�JphK& xr 1 i'M$t �+ .+ t •e-h Sxh b' 5 ,t, . S E y `t` Ji "" y g Yk' vrP � r s " '.$,`:�1� t �. . ;� .g .:•� P...� -�,r � atw r.a �i� "� E...S� 4ki �, terk` f'. f,`vk � a ",.i•, ..� til � � � �`«`� � .5. f .S7'.`�r� i� �<a ' . 3-".� fit. yJf k.d , r•. [' tii y �, li"'�w a J3�' . w y r ' t •r S r.. 'S .$ 2V4 •.i ,'sL`.`i, {•�;: r'• k y" s5!� ' .f.. +, 4? r 'd�+ '� ° 'i w.^�. wk E. �'^P r C+, fi � }} i a" '�.'n;,e7 p-r . � ;. r'" • rd• fi wT-1 r trt.. r t r ro t � J ., �wr• � d � �.-t?� �.D ••ytj x .y2 Boys 8 Gids Clubs of Indian Rlver County, Inc. South County Branch UNIFORM GRANT APPLICATION FUNDER SPECIFIC BUDGET PROGRAM EXPENSES AGENCY/PROGRAM NAME : Boys & Girls Clubs of, Indian River County, Inc ./South County FUNDER : CSACA B c FY 04/05 FY 04/05 % OF TOTAL FUNDER TOTAL VS . PROGRAM SPECIFIC FUNDER REQUEST BUDGET BUDGET col. 13/col. A) EXPENDITURES 21 Salaries 79 , 118 . 00 27 , 000 . 00 34. 13 % 22 FICA 59128 .00 2 , 065 . 50 40 . 28 % 23 Retirement 6 703 . 000 . 00 0 . 00 % 24 Life/Health 8 , 317. 00 934. 50 11 . 24%° 25 Workers Compensation 11797. 00 0 . 00 0 . 00 % 26 Florida Unemployment 635 .00 0 . 00 0 . 00 % 27 Travel-Daily946 . 00 0 . 00 0 . 00 % 28 Travel/Conferences/Train in 31750 . 00 0 . 00 0 . 00 % 29 Office Supplies 967. 00 0 . 00 0 . 00 % 30 Telephone 2 820 . 00 0 . 00 0 . 00 % 31 Postage/Shipping 0 . 00 0 . 00 #DIV/01 32 Utilities 8 , 300 . 00 0 . 00 0 . 00 % 33 OccupancylBuilding & Grounds 25 745. 00 0 . 00 0 . 00 % 34 Printing & Publications 1 750 . 00 0 . 00 0 . 00% 35 Subscri tion/Dues/Membershi s 1 , 200 . 00 0. 00 0 . 00 % 36 Insurance 4, 824 . 00 0 . 00 0 . 00 % 37 Eg ui ment : Rental & Maintenance 19175. 00 0 . 00 0 . 00 % 38 Advertisin 250 . 00 0. 00 0 . 00 % 39 Equipment Purchases : Capital . Expense 0 . 00 0 . 00 , #DIV/0 ! 40 Professional Fees ( Legal , Consulting ) 0 . 00 0 . 00 #DIV/O ! 41 Books/Educational Materials 4 , 308 . 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 Ex ense 11750 . 00 0 . 00 0 . 00 %° 45 Specific Assistance to Individuals 0 . 00 0 . 00 #DIV/O ! 46 Other/Miscellaneous 837 . 00 0 . 00 0 . 00 % 47 Other/Contract 0 . 00 0 . 00 #DIV/0 ! ti�j- 48TOTAL .1 $ 160 ,420 . 60 $30 , 000800 18 .70% ': lu.....:VYY F` .. • 41 lief"4jy{'I` h 1 � Y +. j. . a V f Y .�4n� � 1 t f ' R �i. F >it�•j d •ty .p . {a . � � t 1• yt ¢ '. ��J�`. .y � a h 3' "'. °v � , � r ' � }. rtd a •2y" h3 � r }'' 3 7a r � Fj ' x n � 7 i � ; sixi'4y �.g d ^�'�"'� "�7 $ ' '�^ tax is ��"•�A '�u'N�� � . t J � B°p & GkW Clubs M Indan RNar C°uny, Inc. Sc M County Branch UNIFORM GRANT APPLICATION EXPLANATION FOR VARIANCES OF 15% OR MORE TOTAL PROGRAM BUDGET )GENCY/PROGRAM NAME: Boys & Girls Clubs of Indian River County, Inc./South County Branch FUNDER : Children's Services Advisory Committee EIRE #DIV/0I EJCPLr4NAj7OFOR VAR/ANCE �n f^ #DIVl01 #DIVl01 #DIVIO1 #DIV/0I #DIV/01 #DIVl01 #DIV/01 #DIV/01 #DIVl01 #DIV/01 #DIV/01 #DIV/0) Retirement Antici sting more full time staff members becoming eligible for 10% of salarypension plan. Travel-Dail Ad'usted to account for more staff members turning in mileage reimbursements. /01 ities Utilit costs continue to increase from year to year. Printin & Publications Accounting for increased need to keep earents informed and maintaing an advisory committee. Boys & Girls Clubs of America dues were not previously divided over the 3 programs in the budget - they are now which accounts for Subscri tion/Dues/Membershi Is the variance. Insurance I Insurance was not previously divided other the 3 programs in the budget - it is now which accounts for the variance. E ui ment:Rental & Maintenance New leased copier and maintenance and child tracking sottware maintenance. #DIV/01 #DIV/01 Books/Educational Materials Increased push for training of staff and need for more program supplies. #DIV/01 #DIVI01 #DIVIOM! iscellaneous Increase in cost of background checks and drug screens. #DIV/0 . � �' r . �tt - + �k � }t� y , Y o•� " . � + r � �, to n t' -. � °j*v `t Jt"Str h +F �r r �e 'a a 3 '�, e^r 4r 'fi'. "`1 •. .. »Rt T s', 9 tk r r rx. } ' - " �;., ,r �" !h 1` M• to �p 5i��yy "G �. . . tyrzt xa } P @ !�. , r I. , w, x - f Boys d Gkb Clubs of Indan Rim County, km South County Brooch UNIFORM GRANT APPLICATION EXPLANATION FOR VARIANCES OF 15% OR MORE FUNDER SPECIFIC BUDGET GENCY/PROGRAM NAME : Boys & Girls Clubs of Indian River County, Inc ./South County Branch FUNDER: Children 's Services Advisory Committee �INE"�'fiE1,V1 �. . : ,. � . _. _ TEXPL4IVAT,,ION«t=0fi VAI2CANC Salaries Our request asks for the funding of our FICA Branch Directofs salary/benefits which is 34% of the Program's Bud et. Our re uest asks for the fundin of our Branch Directors salary/benefits which is 34% of the Program's Budget. #DIV/01 #DIV/01 #DIV/01 #DIV/01 #DIV/o1 #DIV/01 f 41 f 41 � �. Wryxa ` ate ,"r R ... ': 1{F !.A•. V4. � 3 }d ) � i? ' l�` � k Y. r �Y� � � Y � � � � � � p, SRI/1007 �a a _ it 7a, r r% ��"f ,1�+. ` 'S' � "st e > y�A� , •' 't^ s { ;:S ret x ° r:,•l "y' "! f �; � � it: 3r� ¢ � d � ,/' 1p / 23 / 2+004 11 . 23 5612993840 BAYS GIRLS CLUB IRC PA02 a % moi) Wbl) ) U : 4 F'AX HUJJ GE ne;,� uaK � �! :� ti .+ �, r ,� , G , • if4mNAL RL yrr n SERVICR L)EVARTN"7 Or T14E ? - 0 , BOX 7508 CINCINhATi , �}; 45Zd1 Employe _ rdentifi.cation Xuemhr_ r : Date: i � � " V s9 - 1s2329e DLN : 1705307i00Go3G BOYS 4 GIRLS CtrLu21 or rVmrAN RIVER Contact Perron : COMM INC 7VONM LNGETT IU,~, 31296 917 $RACXLIIMA 8LVII Contact Talephonc Nun'ljer : VERO BEACH ? FL .129163 ( 877 ) 824 - 3500 . Accounting Period Ending : Ltcember 31 : Foulmidat4cnn statl4s C ] a86ificsLScn : 509 ( a ) ( X ) A4vance Ruling Period Begins . February 4 . 2800 Advance Ruling Period Enda : pegmi er 31 , 3004 Adde 4%4m Appilee �7a , Asaz App3tCant + Based Ars 3rtfozmacion You supplied , . and aueumirg your operations will be as stages In your apglitation ZOL rscogT, itivn of erampticu , v+e have den &Xmined y40 are txcerTt from federal ineame tax under # action 50 ,1 ( a ) of the Internal Revenue Cock as an a:gahttation described in suction 5ol ( c ) ( 3 ) . because you area newly er4 &ted organi : Ation , w* : Urr not new making s final dttcminntion of your rbuh& ctcn statue undex section 509 ( a ) of chs Code . uovcver , we hare daterminsd that you Casa rento::a:.bly e� set to be a puhl '- Cly supported orgl4Uisa6tSO4 coacr.bed in sections 508 ( a ) ( 1 ) and 1'7o ( t ) ( 1 ) (A ) ( vi ) . Arcordih<Sly . during ass advance rul• irg period you will he t ,tdated ag as publicly supported organization , sued not as a private fouttdaticn . Thie advance ruling period lbrginm and tndis an the dater, ohown abova . Within 90 days kfter the and of your advanc4 ruling pariod , You "Nar se -d us the ;. Qfvrmation needed to ¢cter7dna vrheth&z you have mot the requizc - mants of the applicable suppvrC Leet du :: nq the advance ruling pariod . It you establ4vh that you hgve been a publicly supported ozganiration , we will dlarei - fy you IIx A osctiox% FOP ( s. ) ( 1 ) or 509 ( a ) ( z ) orgarsiyatior. as luny as you cont : nor to meet the requirem=ty o £ the sppllc &b1c supporr. tr, 3t . If you do not WL= ct the p'1blic support requiremmcs during the adYance ruling period , we will clawaify you A$ a private foundation for futuro periods , Alco : if we claeew . v Ycru FP a private Coussdation , we will . treat you rr p piivestc fouzdaticn : rom your bapiunjng dace for purpoaes of aee : : on 507 ( 4 ) aA 4940 . Grantors and contribuz. axs tmay Lely on our determination thAt you Are not a private foundation until 90 d % es after the end of your advsknce rulirg Period . If you trend up the xaq"4irad intormat7on within the 3c daya , grantors cad contributoro may concinLtt to rely on the adyanct dntezmination until we matt Leger 1045 ' Do / :c , 10 /23 /,3004 11 : 23 5612993840 BOYS GIRLS CLUE IRC FACE 03 k6 w0b , dUI; U PLO LU : 4J tAA SUJJ Itt;\ ULA' Q-N hi .,% L Yi dc. U4 ; uU6 ♦ Y� P • c� EOYS t' GIRLS CLVH Or liv'DIA$1 91vF7t a : ina1 der. ez^einacion of your foundation etatuo . Lf we publish a T= tLcr, in ch4 Internal Revenue Bulletin ecating than HC W1 " 1 no longer treat you at. a publicly supported organization , granters and concributora mxy not rely on' this dcterminacior, afrar toe date arc publish t .13< roCiCe , Lr. addition , if y.au lose your vta [ue as 4 puh3icly aupporced orrtani - Cation , and a gra.tttor or c �ntrjbu ; 1ZI2 ' ? 2PO4 11 : 23 561299 '"x840 1 .0YS GIRLS CLUB IRC PAGE 04 . 3 - BOYS s, GIRLS CI,VB OF IMIAN RIVER that you vxeaed the $2S . COC Chin$ threshold avert if yomie sournev of ouppart CID nct watid : y ':,he public support rac; t specified in the headin,, of this ietrer . If a xe �. urn is re. quirisd , i . must be filtd by the Inch day of the £ i £ th month after t % q end o £ your annual areouncing period . A penalty of 9 : o a day is charged Uh.mh a return is Filed late . unless there is reasonable cave * toc rhe delay . Howtver , thu maximum pon2lty charged d==int exceed 520 , 000 or 5 percent of you.z gross rtceipta ter the yens , witichevex is less . nor or94n1zatiPnv with groos receipte exce4tdlntt $ 1 , 000 , 00o in any year , the penalty is 5100 pez day per retux—Z , unless theta ie rescmnable cause for the delay The ruaximum penalty for Kr: organization With gxopt receipts exceeding OV1 . 000 , 000 shale. pot exceed S50 , 000 . This penalty may also be charged if a return is not vumpltce . fb , please be sure your rctum : c complete batore you fila it . You are noc required to file federal income tzx retu=iz unless you are sub ; eCC tO the Lax on unrelated "usineze iACome under section 511 of the Code . T4 you art oubjcct tc thic tps: , you must = ile an incomt tax return on Yo . sa 990 - T , Exempt 0,-ganizatior. 4Usineso InComt Tex Return . In this letter we are -not determining whether any of your present ur peopoxed >ict_ ivities are uSa . - a W later tzad.e or businebs a6 definF.d . in vection 513 of the code . You are required to make your annual irfoxmution return , Foinn 330 or Form 950 • 32r . available for public _ nspeetien ;or three yerars atzur the later Of the dYe da.tc of the return or the date th;e return to filed . You are also required to Make ftytilablc fax public invpectioa your exemption application , any Supporting documents , and your examption letter . topics of these doaurncnba axe also required t4 Ac provided to any individual upon written cr in pwrvOn request without charge ozhor than reavonable fags for copying and poatuge . You ra,sy fulri. la thlu zaquirenent by placin5 thasbe docurnenta on thk, Interned . PenzItiea may bt iazporled for failure to co" ly with these ree& iran',ent6 . Additional info= &tion 7. 0 aavailGble in Publication 557 , T &x • Bxempt Status for Ifoua: 0rganitation , or you may stall our tol„ fr4: e number shown above . You need v, employer idoirifitat4o5 number even it you Have no employeaw . If an Omplayer : dentifioation number Naa not entered 'or. your application , we will ace : gn a number to you and .advice you of it , Plehae: use Cid » number on all returns yoti: file and in all aoxreapoC.denca with the Internal Revorue Serv1C � . It we said G tho heading of this loiter that sn saddandum s.pplies , the addtndum eAciozmd is. an izitrVrel part _� f this letter . Becaue,e this ltttor could help us zesoly% any questions sbaut your exeosp �: OtAtva and ! O =dation 4CA. tus , you should keep it in your permantnt recor3s; - Le : t4 ; 1045 ( DO , 1,0 / 00/ 2004 11 : 23 5612993840 BOYS GIRLS CLUB IRC PAGE 05 r , w • 4 - BOYs GIR1.'s -=Um or :)MIAN RrVZA if you haves a=y queatiaris , please corr_acc the person whace aw a ara Ce e� i� orie fWalLer are shicwG 4n tsa hesdinq 04 Chis « ecter . finca _e3y yours , Stevca . ; . Millrr Dir: ceor , Lx0crpk Orcanicacian� caiciuzure ( a ) : Form Q " :. c AacCar '� 005 ; p� ( CGt 7Orr..t. : 05