HomeMy WebLinkAbout2004-229G � Z
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 Indian River County Healthy Start Coalition , Inc . ("Recipient") , of:
go
1603 10th Avenue
Vero Beach , Florida 32960
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 .
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s
4 . Grant Funds and Payment The approved Grant for the Grant Period is Fifty- Five
Thousand Dollars ($55 , 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 :
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( 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 .
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IN WITNESS WHEREOF , County and Recipient have entered into this Contract on the date
first above written .
INDIAN RIVER COUNTY BOARD OF COUNTY COMMISSIONERS
By �.
Caroline D . Ginn , ChairrrTgn
BCCARpftoved : /d ' /o2 O �`/ Tal
^ t
Attest : JI(-.. , Barton , Clerk
Mlaull
By
LAE R Deputy Clerk
Approved : ' .
Jose0h A. Baird
" County Administrator
App as t form an legal sufficien :
ell , Assi tant Co t orney
RECIPIENT :
. I ��j
By:
Indian River County Healthy Start Coalition , Inc .
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EXHIBIT A
[Copy of complete proposal/application]
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Organization : Indian River County Healthy Start Coalition, Inc. Program: Healthy Families — IRC Program
Funder: IRC Board of County Commissioners — Children 's Services Advisory Committee - 2004 Grant Application
PROGRAM COVER PAGE
Organization Name : Indian River County"Healthy 'Start Coalition Inc
Executive Director: D . Scott Joseph M. S . Email : irchsc6a aol . com
Address : 1603 101h Ave . Telephone : (772 ) 563 -9118
Vero Beach, Florida 32960 Fax : (772) 563 -9125
Program Director: Dina Kramer Email : dkramer ,exchangecastle org
Address : 673 US Hwy 1 Telephone : (772) 567-5700
Vero Beach, Florida 32962 Fax: (772) 567-7133
Program Title: ealtfiy ramilies IRC ,
Priority Need Area Addressed: Parenting Support and Education as well as Mental Wellness
Brief Description of the Program : The taxonomv definition for the Healthy Families program is PH
236 . 240 — Family Support Centers . Healthy Families—IRC is a community based voluntary home visiting
program designed to promote positive parent-child interaction and child growth and development therefore
enabling children to grow 0 healthy safe and nurtured While the Healthy Families program is not a
support center, the staff provide a wide variety of social services that are designed to promote and support
healthy development of families help families cope towards mental wellness improve family interaction
skills and help at-risk families to resolve problems in the pre-crisis stage before they become
unmanageable and child abuse takes place
Amount Requested from Funder for 2004 / 05 : $ 55 ,000
Total Proposed Program Budget for 2004 / 05 : $ 4989985
Percent of Total Program Budget : 11 , 0 %
Current Funding ( 2003 / 04 ) : $ 55 , 000
Dollar increase / ( decrease ) in request : $ _
Percent increase / ( decrease ) in request : 0 . 0 %
Unduplicated Number of Children to be served Individually : 194
Unduplicated Number of Adults * * to be served Individually : 170
Unduplicated Number to be served via Group settings : _
Total Program Cost per Client : 1370 . 84
* * Does not count father or significant other
If these funds are being used to match another source, name the source and the $ amount : $443 , 985 . 00
Florida Ounce of Prevention — Healthy Families Florida
The Organization 's Board of Directors has approved this application on (date). May 26, 2004
Jean Anderson
Name of President/Chair of the BoardLZ
ature
D. Scott Joseoh
Name of Executive Director/CEO Signature
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Organization : Indian River County Healthy Start Coalition , Inc . Program: Healthy Families — IRC Program
Funder: IRC Board of County Commissioners — Children ' s Services Advisory Committee - 2004 Grant Application
PROPOSAL NARRATIVE
A. ORGANIZATION CAPABILITY (Entire Section A not to exceed one page)
1 . Provide the mission statement and vision of your organization. The mission of the Indian
River County Healthy Start Coalition is to establish a system that guarantees all women have access
to prenatal care and that all infants have access to services that promote normal growth and
development. The vision is to provide the resources and mechanisms available in Indian River
County that lead to healthy birth outcomes and brain development. The Vision/Mission Statement
for the HF4RC program is "To enhance parent' s ability to promote and maintain healthy family life
through education and coordinated support which is individualized for each family. "
2 . Provide a brief summary of your organization including areas of expertise, accomplishments
and population served. The Coalition ' s purpose is to provide coordination and build broad-based
community support for maternal and child health (MCH) . This is accomplished by establishing a
partnership between the private and public sector, state and local government, community alliances
and maternal and child health providers to provide coordinated community based care for pregnant
women, infants and families with children up to age three for Healthy Start and age five for Healthy
Families . Areas of expertise include birth and maternal data analysis, program planning,
development, implementation, and addressing gaps in MCH services . Once gaps in service or poor
birth outcome trends have been identified, then the necessary steps are taken to improve these gaps in
care by building bridges, linkages or adding new services if they currently do not exist to meet the
MCH needs in Indian River County. Additional areas of expertise include outreach, providing
educational opportunities addressing MCH issues, and ensuring a system is in place for pregnant
women, infants and children.
The Coalition serves as the lead agency for Healthy Families — IRC in partnership with the Exchange
Club C .A. S .T.L. E . , who is the contracted service agency. The program has provided intensive case
management to over 100 families each year since 1999 , with the primary goal of preventing child
abuse in at-risk families. The IRCHS Coalition also developed and put in place the TLC Newborn
Program in 1998 , which serves approximately 1 ,000 infants each year, as well as the parents of these
newborns . In addition, the Coalition oversees Healthy Start Care Coordination services in
partnership with the Indian River County Health Department, which served over 500 families in
2003 . Beginning in 2003 , the Coalition launched a child safety campaign and became a Safe Kids
Chapter in January. The vision of Safe Kids is to "Protect the children of our community . . . through
education, outreach and community involvement" . The Safe Kids programs focuses on child
passenger safety, infant, home and bicycle safety education and initiatives . The program has - already
proven to be extremely beneficial in bringing new resources to the community by getting over 120
child safety seats donated from the state, with potential Department of Transportation funds available
for additional seats and safety interventions . To date, over 300 child passenger seat inspections have
taken place by the Coalition ' s Outreach Coordinator, who plans and coordinates the Safe Kids
program . Safe Kids has either coordinated or participated in over 20 safety event in 2003 -04 .
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Organization : Indian River County Healthy Start Coalition, Inc . Program: Healthy Families — IRC Program
Funder: IRC Board of County Commissioners — Children 's Services Advisory Committee - 2004 Grant Application
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. What : Pregnancy and raising a child places many
new or additional burdens and stressors on a family, including financial, emotional and even physical
stress . Along with the joys of parenthood can be the realization of the major responsibilities of
raising a child to be healthy and ready to learn by the time they enter their school years . HF focuses
on families with risk factors for child abuse addressing parenting components that will improve
parent/child interactions and enhance overall brain development. b. Who . Factors associated
with increased risk for child abuse, poor birth outcomes and poor infant/child growth and
development include: marital status, age of mother, moving three times in one year, alcohol or
substance use, high stress level, not wanting the pregnancy, depression, history of mental health
counseling, and partner being unemployed. In many cases, these risk factors are more prevalent for
low income families. Indian River County residents had 1 ,056 births in 2002 . Of these births,
62 . 8 % were from white mothers, 15 .3 % black, 19 . 0% Hispanic and 2 . 9% "other" mothers. In
2002, almost half, or 45 % of all births are covered under Medicaid or indigent funding, which
amounts to 475 babies being from low income families . Of all the births in 2002 (the latest year
for complete birth data), 39 . 6 %, or 418 babies, were to unwed mothers, with black unwed births
at 76 . 5 % . In terms of education status of the newborn' s mother, 28 .3 %, or 299 of the mothers
did not have a 12'h grade education or GED . c. Where . Healthy Families — IRC serves families
from the entire county, with 53 % served from south county, and 47% from the north county area. d.
Corraboration of Area of Need : The HF program is modeled after the highly successful national
HF America initiative that is based on critical program elements that have been defined by over 20
years of research and represent best practices in home visitation. Only three reported child abuse
cases for families receiving HF-IRC services have occurred since 1999, which is noteworthy since
these families are at greater risk for committing child abuse .
2. a) Identify similar programs that are currently serving the needs of your targeted
populations b) Explain how these existing programs are under-serving the targeted population
of your program. Healthy Start Care Coordination provides ongoing case management to high-risk
families, placing emphasis on the pregnant woman to help ensure a healthy birth outcome, as well as
pregnant women or infants with medical risk factors. Typical caseloads in the Healthy Start program
are 50 pregnant women and/or infants per Healthy Start Care Coordinator. Statewide, the Healthy
Start program is only funded at 47 percent of the true at-risk client needs. Due to the complex and
labor intensive problems addressed, Healthy Start Care Coordination only provided 91 infants and
their families ongoing care coordination in 2003 . This leaves almost 1 ,000 families with Uewborns
that might be at risk for child abuse and could be eligible for Healthy Families . The program is
designed to work on parent/child bonding and interaction with the target child until the child reaches
age five . Healthy Families also requires that low caseloads be maintained at an average of 20 families
per worker, but no more than 25 . The low caseloads and the extended duration of services greatly
enhance the opportunity to positively impact families . Healthy Families-IRC is the only program in
Indian River that is designed to stay with families for up to five years ,
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Organization : Indian River County Healthy Start Coalition, Inc. Program: Healthy Families — IRC Program
Funder: IRC Board of County Commissioners — Children 's Services Advisory Committee - 2004 Grant Application
C. PROGRAM DESCRIPTION (Entire Section C, 1 — 6, not to exceed two pages)
1 . List Priority Needs area addressed. Parenting Support and Education & Mental Wellness
2 . Briefly describe program activities including location of services. The primary location of
services takes place in the family' s home . Healthy Families is a voluntary, intensive home visiting
program that occurs on a weekly basis . Family Support Workers (FSW) , who are trained
paraprofessionals, provide case-management services focusing on parent/child bonding, infant/child
growth and development, ensuring well baby care and immunization schedule compliance and
support the family empowering them to set and achieve goals . Family caseloads for the FSW ' s are
by design, kept to under 25 families, to ensure the intensity of the home-based services are
manageable . HF can initiate services either prenatally or up to two weeks after the birth of the target
child. HF Florida and the Florida Department of Health have collaborated to develop a Universal
Prenatal Screen. The screen is offered to the pregnant woman on her first obstetric (OB) visit with
her prenatal care provider. In Indian River County, during the spring of 2001 , a Screening Liaison
position was provided by the IRCHS Coalition to Partner' s In Women ' s Health, (the primary OB
provider for pregnant women who have Medicaid or are indigent) in order to better coordinate the
screening process and ensure that the pregnant woman is referred to the program (HS or HF) that
can best meet her needs based on the risk factors presented. The implementation of this Screening
Liaison position has dramatically improved the referral process and has eliminated any duplication of
services . HF—IRC receives the screens from the HS Care Coordination (HSCC) office and makes
contact with all pregnant mothers who had a positive screen for HF. HF focuses on parenting
education and services directly related to parent/child bonding and infant care and development.
Once the positive HF screen is received, the HF-IRC Family Assessment Worker (FAW) contacts the
HSCC office to determine the status of the pregnant woman and if she is being served by HS Care
Coordination. The FAW conducts a face-to - face two-hour comprehensive assessment to determine if
she would be eligible for HF services . If the pregnant woman is eligible after the assessment for HF
and is not receiving HS services, then on-going HF services would begin. The majority of all HF
referrals come from the HS screen prenatally. However, referrals can take place within two weeks
after the birth of the infant. Postnatal referrals routinely come from the Indian River Memorial
Hospital (IRMH) representatives after delivery.
For the first time since the inception of the HF-IRC back in the summer of 1998, eight families
"graduated" from the HF-IRC program in the summer of 2003 . Of these families, seven were
employed and two have increased their level of education at the time of graduation. Of these eight
participants, six were unemployed at the time of entering the HF-IRC program. One hundred percent
of the families being served have conformed to their well child/EPSTD standards (which includes
immunizations), with 100% of the families surveyed showing overall satisfaction with services .
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. HF focuses on families with risk factors for child abuse addressing parenting
components that will improve parent/child interactions and enhance overall brain development. The
HF program is modeled after the highly successful national HF America initiative that is based on
critical program elements that have been defined by over 20 years of research and represent best
practices in home visitation. As mentioned earlier, only three reported child abuse cases for families
receiving HF-IRC services have occurred since 1999 . HF Florida, which is the state-based
administrator of the all HF programs , contracted with a research and evaluation firm to do overall
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e Organization : Indian River County Healthy Start Coalition, Inc , Program: Healthy Families — IRC Program
Funder: IRC Board of County Commissioners — Children 's Services Advisory Committee - 2004 Grant Application
program evaluation . In a report presented in April 2002 , it found that 98 % of all children who
participated in HF had no finding of child maltreatment or substantiated child abuse. The national
HF initiative has many years of research and has demonstrated that home based case management,
parenting education and child development has been the most effective means for addressing parent
support and education as well as mental health and wellness .
4. List staffing needed for your program, including required experience and estimated hours
per week in program for each staff member and/or volunteers. Project Manager ( 1 Full Time
Equivalent - FTE) - Masters degree in social work, psychology, or a related field (or BA with 2
additional years of experience in the field), and/or 2 years experience in direct service delivery and
supervision. The primary role is to provide leadership, direction and overall program supervision for
all HF— IRC staff. Supervisors ( 1 . 5 FTE ' s) - Masters degree in social work, psychology, or a related
field (or BA with 2 additional years of experience in the field), and 2 years experience in direct
service delivery and supervision. Duties are to report to Program Manager, provide direct supervision
of FSW' s and to review caseloads of HF-IRC staff. Family Assessment Worker ( 1 . 5 - FTE ' s) -
One-year college credit in a related field, with two years of experience delivering services to children
and families . Duties are to review referrals made by OB providers or other sources in the
community. For all referrals, interviewing/conducting the eligibility tool with parents to determine
eligibility for HF. Family Support Worker (8 FTE ' s) - One-year college credit in a related field,
with two years of experience delivering services to children and families . Responsible for initiating
and maintaining regular (at least weekly) and long-term contact/support with families . Data Entry
Clerk—Admin. Asst. ( 1 FTE) - Accurate and timely information processing; experience with data
entry computer systems . Duties include the review of master copies of documents; updates HF—IRC
database.
5. How will the target population be made aware of the program ? The primary site for reaching
potential HF clients is through the Screening Liaison located at Partners in Women' s Health .
Partners is the primary obstetric Medicaid provider in this county, whose patients would most likely
be eligible for Healthy Families . The Screening Liaison provides orientation on the HF program
during new client intake days at Partners, which is every Friday morning. IRMH is also a source for
HF program referrals. Because the IRCHS Coalition is the lead agency for HF-IRC , awareness is
also created through The Coalition ' s networking, and it' s three other programs (Healthy Start, TLC
and Safe Kids) . The CASTLE also assists in marketing the program as well as individuals from the
Coalition ' s Board of Directors, partnering agencies and other not-for-profit programs . The Coalition
also promotes the program through its newsletter, public presentations, bi-monthly Coalition
meetings, and at health fairs or other public events . ,
6. How will the program be accessible to target population (i. e. location, transportation, hours
of operation) ? The HF-IRC program can serve the entire county. Since HF-IRC is a home-based
visitation program, there are few barriers for program participation. The FSWs have flexible hours
and can work nights or Saturdays in order to visit families at their convenience . The FSW ' s can also
meet families at their OB or pediatric providers offices, WIC or any other convenient location.
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' Organization : Indian River County Healthy Start Coalition, Inc . Program: Healthy Families — IRC Program
Funder: IRC Board of County Commissioners — Children 's Services Advisory Committee - 2004 Grant Application
D . MEASURABLE OUTCOMES (Entire Section D not to exceed two pages)
OUTCOMES ACTIVITIES
Add all the elements or the Measurable Outcomes Add the tasks to accomplish the Outcome(s)
Note : These outcomes and activities are based
on the standard HF Florida and national HF
program guidelines and requirements.
1 . Ninety (90) percent of target children will be 1 . FSW ' s will address immunization schedules
fully immunized by age two (2) . with family and record usage.
2 . Ninety (90) percent of target children will be 2 . The Well Baby checkups will be monitored,
up-to-date with Well-Baby Checks . with the infant ' s medical home established.
Families will be encouraged to seek and utilize a
pediatrician and/or clinic for ongoing medical
care for infant and child.
3 . Ninety-five (95) percent of the children in 3 . FSW' s will address proper parenting skills
families who participant in HF-IRC for six with family, as well as Shaken Baby Syndrome
months or longer will have no findings of some Education, partner interaction and anger
indications or verified child maltreatment while management.
receiving Healthy Families services .
4. Ninety-five (95) percent of participating 4. Outcomes Satisfaction surveys will be
families will report an overall satisfaction with distributed to all HF clients on an annual basis to
the service they receive. determine client' s satisfaction with the program.
5 . At least eighty (80) percent of all assessments 5 . The Family Assessment Worker will conduct
must occur either prenatally or within the first assessments per referral during the target period
two weeks after the birth of the target child. for HF client enrollment.
6 . Ninety (90) percent of families enrolled 90 6 . All FSW ' s will complete a Family Support
days or longer will have updated their Individual Plan for enrolled clients, developing mutual
Family Support Plan within the previous ninety goals and activities the family will strive to
days . obtain.
7 . One hundred ( 100) percent of eligibility 7. All potential HF clients will be given an
assessments will be conducted using a eligibility assessment as part of the enrollment
standardized tool , process in Healthy Families.
8
' Organization : Indian River County Healthy Start Coalition, Inc. Program: Healthy Families — IRC Program
Funder: IRC Board of County Commissioners — Children 's Services Advisory Committee - 2004 Grant Application
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
The C.A.S.T.L.E. * Provides day to day administrative and fiscal
(Contracted service agency for management of HF-IRC service staff.
HF-IRC services) * Assist the IRCHSC in marketing and increasing
awareness of HF4RC in Indian River County.
* Provides in-house programs for referral to HF-IRC and
from HF-IRC families.
All these services are provided in-kind, with no
administrative fee from BOCC-CSAC.
Indian River County Health * Provides coordination of HS/HF prenatal screen.
Department * Communication on potential HF client ' s status.
* Medical/nursing based services for HF client on an "as-
needed" basis.
* WIC and needed health care services at CHD clinics.
All these services are rovided in-kind
Indian River Memorial Hospital * Provides referrals to HF-IRC program from Delivery/
Nursery Department for identified high-risk families.
All these services are Drovided in-kind.
IRC Library — Born to Read * Provides two books to newborn families that are given to
Program the family of the newborn by the Stork Club. The HF-IRC
emphasizes the importance of reading to their infant
towards enhancing brain development.
All these services are rovided in-kind.
Visiting Nurses Association of the * Provides Home visitation for mothers of newborns
Treasure Coast experiencing breastfeeding difficulties or in need of greater
breastfeeding education.
Partners in Women' s Health * Primary site for Healthy Families referrals . Partner' s
employs, under contract from the Coalition, the Screening
Liaison who provides HF4RC orientation, education, and
processing of the Universal Screen,
Indian River County Healthy Start * Overall program development, integration anti
Coalition communication within all four IRCHSC programs .
* Fundraising, PR and marketing of HF-IRC program
(While the Coalition is the applying * In cooperation/collaboration with the Exchange Club
agency, many in-kind collaborative CASTLE, HF-IRC Program QA/QI, reports .
efforts on behalf of the HF-IRC * Provide HF-IRC representation at public events
program take place) * Presentations to community groups re : HF-IRC
* Development and presentation of HF-IRC Grant(s)
* Fiscal oversight and reimbursement requests .
All these services are provided in-kind, with no
administrative fee from BOCC-CSAC.
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Organization : Indian River County Healthy Start Coalition , Inc . Program: Healthy Families — IRC Program
Funder: IRC Board of County Commissioners — Children 's Services Advisory Committee - 2004 Grant Application
F. PROGRAM EVALUATION (Entire Section F not to exceed two pages)
1 . DEMOGRAPHICS : What information (data elements) will you need to collect in order to
accurately describe your target population including demographics (age, gender and ethnic
background) required by the funder in Section H? What are the pieces of information that
qualify them for your target population ? How do you document their need for services or their
"unacceptable condition requiring change" from Section B19 Comprehensive data on each HF —
IRC family who enrolls is entered in a Healthy Families database, developed by Healthy Families
Florida. This data includes demographic information. The parent(s) and the Family Support Worker
monitor infant developmental stages, with updates documented in the family record. HF — IRC
participates in statewide evaluation and provides outcome and performance data in the format and
frequency specified by Healthy Families Florida. The HF-Florida database is updated on a weekly
basis, with reports also generated on a weekly basis, which is provided to the Project Manager and
Supervisor, who then share the general information and/or discrepancies with the appropriate FSW.
The Healthy Families Florida Contract manager performs sites reviews on a quarterly basis, as well
as Coalition and HF-IRC Advisory Board reviews . For 2002-03 , the HF-IRC program finished in the
to five of 40 plus HF programs, for meeting its program goals and objectives .
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 ?
The outcomes are based on data needed by HF Florida (HFF) as well as HF-IRC, which are compiled
and entered into the HFF database at regularly scheduled intervals . Based on strict HFF criteria,
families develop goals based on their assets and needs, and must achieve these through the program
to "graduate" to higher levels, which would need less intensity of services , which empowers the
family to become self-sufficient. The required data and outcomes are monitored by HFF, as well as
locally by the HF-IRC Program Manager and the Coalition . These measures are based on 30 years of
research by Healthy Families America.
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? Database is
compiled and updated on a weekly basis, with reports also generated on a weekly basis th4t the FSW
and Supervisor review. Monthly reports are provided to the HF-IRC Advisory Board, and quarterly
reports are submitted to the Coalition and CSAC .
Data and programmatic reports are submitted to the HF-IRC Advisory Board on a monthly basis, the
Coalition Executive Director and Board of Directors on a quarterly basis, the HFF Contract Manager
on a monthly basis, who also conducts on- site QA/QI every three months . Reports are provided at
the public Coalition meetings bi-monthly. All of the QA/QI partners , which include Healthy
Families Florida, the Advisory Board and the Coalition address program outcomes from a global
sense and work towards strategies and solutions that can be shared with the HF-IRC service staff,
who then apply the action steps to benefit the families they serve.
10
Organization: Indian River County Healthy Start Coalition , Inc . Program: Healthy Families — IRC Program
Funder: IRC Board of County Commissioners — Children 's Services Advisory Committee - 2004 Grant Application
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 com l ting the timetable, review information detailed in prior sections.
Month/ Activities
Period
Healthy Families — IRC is in its fifth year of operation, and has no start-up steps.
The major steps for the overall program are :
Pregnant women are offered the universal screen by the Screening Liaison at Partners in
Women ' s Health. The voluntary screen looks at risks for child abuse. A consent form is
also signed by the client if they have a positive score for Healthy Families on the universal
Weekly HS/HF screen. Referrals can also come from the social worker at Indian River Memorial
Hospital at the time of birth. Additional referrals can come from any agency in the
community. Families can be eligible for assessment during pregnancy or up to two weeks
after the birth of their child.
The screen is sent to the Healthy Start Care Coordination office for processing. All screens
are then forwarded to the Healthy Families Family Assessment Worker (FAW) for a face-
to-face assessment to determine if they are eligible for Healthy Families. The FAW
communicates with the HS Care Coordination team to determine the potential HF client' s
status prior to performing the assessment.
On-going After the assessment, if the family is eligible for Healthy Families, and is interested in
participation, the Program Manager reviews the case with the FAW. The case (family)
then goes to the HF Supervisor, who reviews the family' s needs and determines the best
Family Support Worker (FSW) for case management assignment. The family is then
assigned to a FSW. Phone contact must be attempted within 72 hours by the FSW. A
subsequent home visit attempt must be completed within 5 days . Once contact is made
with the family, initial goal(s) setting is done within one month of opening case.
Supervision is conducted weekly with all FSW' s for a minimum of two hours, who review
all cases assigned to the FSW. Goals are reviewed and updated with the family and
Supervisor every 90 days. These goals can be modified during 90 days if needed.
For pregnant women, the determination of weekly or bi-weekly visits during pregnancy is
made . After birth, visits are weekly for a minimum of 6 months. Bi-weekly visits can be
done if the mom returns to work, with phone contacts in between.
Six to eight months after birth, the Supervisor and FSW will determine if the family can
move to level two, which is bi-weekly visits . This determination would be based on the
family' s progress in meeting their goals and well as overall family needs .
The Ages and Stages child assessment tool is conducted every four months and goes all the
way to 60 months . The Parent Child Assessment/Observation tool is done at one month,
then every six months . Home Safety checks at one month then six months .
The family and target child have goals and levels to achieve for program graduation,
11
Organization : Indian River County Healthy Start Coalition, Inc. Program: Healthy Families — IRC Program
Funder: IRC Board of County Commissioners — Children 's Services Advisory Committee - 2004 Grant Application
H. PROJECTIONS FOR UNDUPLICATED CLIENTS
Number of Unduplicated Clients by Location
Last Fiscal Year ` Current Fiscal Year Next Fiscal Year
Location Actual 2002/2003 Budget 2003/04 Projections 2004/05
Unduplicated Clients Unduplicated Clients Unduplicated Clients
N. Indian River County* 132 132 171
S. Indian River County* 146 148 193
Indian River Co. Total 278 280 364
TOTAL SERVED 278 280 364
*Counts infant/child and
moth' ( 139 families) ( 140 families) ( 182 families)
* * Does not count father
or partner
Number of Unduplicated Clients by Age
Last Fiscal Year Current Fiscal Year Next Fiscal Year
Location Actual 2002/2003 Budget 2003/04 Projections 2004/05
Individuals Group Individuals Group Individuals Group
0 to 4 - (Pre-school) 139 - 140 - 182 _
5 to 10 - (Elementary)
11 to 14 - (Middle.)
15 to 18 - (High School) 12 - 13 - _
12
Total Children 151 - 153 - 194 -
19 to 59 - (Adults) 127 - 127 - 170 -
60 + (Seniors)
Total Adults 127 - 127 - 170 -
TOTAL SERVED 278 - 280 - 364 -
12
IRC Healthy Start Coalition, Inc.
Healthy Families - IRC
' BOCC-CSAC 2004-05 Grant
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,
FY 2004-05
AGENCY/PROGRAM NAME : IRC Healthy Start Coalition , Inc . - Healthy Families - IRC
FUNDER : IRC Board of County Commissioners = 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
Le used for calculations and to write information only, ;
AGENCY USE ONLY Proposed Total Program Funders Specific REVENUES (SHOW DETAILt P Total
Agency
CALCULATIONS) Budget Budget Budget
1 Children's Services Council-St, Lucie
2 Children's Services Council-Martin
3 Advisory Committee-Indian River55,000.00 559000. 00 709000.00
4 United Wa -St. Lucie County
5 United Way-Martin County
6 United Way-Indian River County 55,000.0
7 Department of Children & Families
8 County Funds
9 Contributlons-Cash
10 Program Fees
11 Fund Raising Events-Net 8 ,000.00
12 Sales to Public - Net
13 Membership Dues
14 Investment Income
15 Miscellaneous
16 Legacies & Bequests
17 Funds from Other Sources 443,985.00 967,679. 00
18 Reserve Funds Used for Operating
19 In-Kind Donations (Not included In total) 63,489.00 93 ,489.00
20 TOTAL REVENUES
(doesn't include line 19)l $498,985.00
$55,000.00 $ 1 , 1009679.00
B C D
EXPENDITURES A� oOR Proposed Total Program Funder Specific Total Agency
NLY
(SHOW CALCULATIONS) Budget Budget Budget
21 Salaries - (must complete chart on next page 319,054.00 519091 .00 687,771 .00
0
Salary
22 FICA - Total salaries x 0.0765 7.65°/ 24,408.00 3 ,908.46 529615.00
e iremen - Annual pension Tor qualified
23 staff 13,000 .00 0.00 31 ,954.00
Life/Health - Medical/Dental/Short-term
24 Disab. $225/mo9 21 ,420.00 0.00 68,891 .00
Workers Compensation - emp oyees x
25 rate 4,594.00 0.00 90903.00
ori a Hemp oymen - proles
26 employees x $7,000 x UCT-6 rate 0. 00 19200.00
13
IRC Healthy Start Coalition, Inc.
Healthy Families - IRC
BOCC-CSAC 2004-05 Grant
SALARIES A
Gross Annual B C D
POSITION LISTING Portion of Salary on Proposed % of Gross Annual
Salary ProgramFunder Specific Budget Salary
Position Title / Total Hrs/wk (Agency) Requested(GA)
Example: Executive Director / 40 hrs 70,000.00 101000.00 50000.00 7, 14%
Program Manager (40 hrs) 35,029 .00 35,029.00 0. 00%
Supervisor (40 hrs) 27,810.00 27 , 810.00 0. 00%
Supervisor/Family Assessment Worker (40 hrq 28,835.00 28,835.00 0.00%
Family Assessment Worker ( FAW) (40 hrs) 24,423.00 249423.00 0.00%
Family Support Workers (8 FSW's) (40 hrs) 181 ,075.00 181 ,075.00 519091 .00 28.22%
Data Entry/Admin Assist (40 hrs) 199282.00 19,282.00 0.00%
Screening Liaison (5 hours per week) 2,600.00 21600.00 0. 00%
#DIV/0!
#DIV/0!
#DIV/0!
IRC Healthy Start Care Coordination 190,000.00 0.00%
IRC Healthy Start Coalition 1229906.00 0.00°/
TLC Newborn Program 559811 .00 0.00%
#DIV/0!
#DIV/O!
#DIV/o!
#DIV/0!
#DIV/0!
#DIV/0!
Remaining positions throughout the agency #DIV/01
Total Salaries $687,771 .00
$3199054.00 $51 ,091 .00
FRINGE BENEFITS DETAIL A
(Funder Specific Budget Funder B C D E F G
Column C only, from line 22 to 27) S cific FICA 7. 65% Pension Health Ins. Worker's Unemployme Total Fringes Funder
�
Position Title / Total Hrs/wk
Budget (A x Vo) Compens, nt Compens. Specific
Example: Case Manager / 40 hrs 51000. 00 382,50 200.00 500,00 300,00 200.00 1058250
Program Manager 40 hrs) 0.00 0.00 0.00
Supervisor (40 hrs) 0.00 0.00 0.0
Supervisor/Family Assessment Worker 40 hr 0.00 0.00 0. 0
Family Assessment Worker (FAW) (40 hrs) 0.00 0.00 0.00
Family Support Workers (8 FSW's) 40 hrs) 51 ,091 .00 3 ,908.46 39908.4
Data Entry/Admin Assist (40 hrs) 0.00 0.00 0.0
Screening Liaison (5 hours per week) 0.00 0. 00 0. 0
0 0.00 0.00 0.0
0 0.00 0.00
0.0
0 0. 00
0.00 0. 0
IRC Healthy Start Care Coordination 0. 00 0.00 0.0
IRC Healthy Start Coalition 0.00 0.00 0.0
TLC Newborn Program 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 0.0
0 0.00 0.00 0.0
0 0.00 0.00 0.0
0 0.00 0.00 0. 0
0.00 0.00
, 1 11111111111 Jill 0.0
Total Funder Request Fringe Benefits $51 ,091 .00 $3,908.46 1 $0. 00 $0.00 $0 . 001 - $3,908-4 - -
14
IRC Healthy Start Coalition, Inc. _
Healthy Families • IRC
' BOCC-CSAC 2004-05 Grant
D
EXPENDITURES GRAY AREAS FOR Proposed Total Program Funder Specific
AGENCY USE ONLY TO p Total Agency
SHOW DETAIL Budget Budget Budget
27 Travel-Daily 121528.00 191000.00
# of Staff x average # of miles/wk x 50 wks x
$ = Estimated Daily Travel/Mileage Reimb. (Avg. 400/mo. 9* 12 mo)
28 Travel/Conferences/Training 3,000.00 119000.00
• National Conference (cost per staff)
• Training/Seminar (cost per staff)
• Other Trainings (cost of travel , lodging, Ongoing training provided mainly by HF
registration , food) Florida
29 Office Supplies 3,000.00 10,000.00
Office supplies (monthly average x 12
months = estimated cost of office supplies
based on present history. ($250 mo avg. )
30 Telephone 71200.00 139950.00
• # 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 ($600/month, including cell phones)
31 Postage/Shipping 1 ,000.00 8,000.00
•Quarterly Mailing of Newsletter
• Special events , etc. $75 per mo which includes client and
• Bulk mailings - appeals newsletter mailings
32 Utilities 3 ,656.00 7,000.00
• Electricity ($ x 12 months)
• Water/Sewer ($ x 12 months)
• Garbage ($ x 12 months) avg. $305 per mo
33 Occupancy (Building & Grounds) 22,812.00 34,618.00
• Mortgage/Rent ($ x 12 months)
• Janitorial ($ x 12 months) .
• Grounds Maint. ($ x 12 months) ($ 1 ,500 mo rent plus maintenance and
• Real Estate Taxes cleaning)
34 Printing & Publications 300.00 51900.00
• Quarterly Newsletter ($ x 4)
• Letterheads, Envelopes, etc.
• Fundraising materials
• Other
35 Subscription/Dues/Memberships 0.00 6,500.00
• Membership to National Organization
• Dues
• Subscriptions to Newspapers/magazines,
etc.
36 Insurance 2,500.00 41500.00
• Directors/Officers Liab.
• Commercial/General Insurance
• Bond Ins.
• Auto Insurance
37 Equipment : Rental & Maintenance 21208.00 91271 .00
• Copier lease ($ x 12 months)
• Meter lease ($ x 12 months)
• Copier Maintenance ($ x 12 months)
• Computer Maintenance ( $ x 12 months)
• Other Copier maintenance and repairs
38 Advertising 1 ,000.00 300.00
• Newspaper ads
• Fundraising ads/promotions
• Other (vacancies )
391 Equipment Purchases : Capital Expense 29000.00 10,530. 00
15
IRC Healthy Start Coalition, Inc. - _ ..... ._.... __
Healthy Families - IRC
- — -
BOCC-CSAC 2004-05 Grant
• Computer/monitor (# x $)
• Laser Printer purchase of 4 computers at $500
40 Professional Fees (Legal, Consulting) 2,812.00 6 ,000. 00
• Legal advice ( estimated #hrs x $)
• Consultant fees
• Other trainer expenses
41 Books/Educational Materials 900.00 2,000.00
• Books/videos
• Materials ($ x staff)
42 food & Nutrition 0.00 0.00
• Meals ( # meals x clients x 5days x 50 wks)
• Snacks
43 Administrative Costs 449398.00 59,546.00
• Admin. Cost (% of total budget) (10% of HFF budget)
44 Audit Expense 4,000.00 14,500.00
Independent Audit Review
45 Specific Assistance to Individuals 0.00 29000.00
• Medical assistance
• Meals/Food
• Rent Assistance
• Other
46 Other/Miscellaneous 570.00 13,500.00
• Background check/drug test
• Other
47 Other/Contract 21600.00 10, 100.00
Sub-contract for program services 50% of screening liaison
481 TOTAL EXPENSES $498,960.00 1 $54,M.461 $19100,549.00
16
IRC IM y Slat Coe .
M MNy Fa *& - IRC
° BOCC.CSAC 200105 Onnl
4
UNIFORM GRANT APPLICATION
TOTAL AGENCY BUDGET
2004-05
AGENCY/PROGRAM NAME : IRC Healthy Start Coalition , Inc. - Healthy Families - IRC
FY 02/03 FY 03104 FY 04105 % INCREASE
FYE_7/1/02 - 6/30/03_ FYE 7/1 /03 - 6/30/04 FYE_7/1 /04 - 6/30105_ CURRENT VS.
NEXT FY BUDGET
A B C D
ACTUAL TOTAL PROPOSED (col. C-col. BNcol. B
REVENUES BUDGETED BUDGETED
1 Children's Services Council-St. Lucie 0.00 #DIV/01
2 Children's Services Council-Martin 0.00 #DIV/01
3 Advisory Committee-Indian River 55 000.00 7000000 70 000.00 1 0. 00%
4 United Way-St. Lucie County0.00 #DIV/0 !
5 United Way-Martin County 0.00 #DIV/01
s United Way-Indian River County 45 000.00 450000. 0 il 55 000.00 22.22%
7 Department of Children & Families 0.00 #1DIV/0!
8 County Funds 0.00 #DIWO!
9 Contributions-Cash 0.00 #DIV/01
10 Program Fees 0.00 #DIV/01
11 Fund Raising Events-Net 12 500.00 800000 -36.00%
12 Sales to Public-Net 0.00 #DIV/01
13 Membership Dues 0.00 #1DIV/0!
14 Investment Income 0.00 #DIV/0!
15 Miscellaneous 0.00 #1DIV/0!
16 Legacies & Bequests 0.00 #DIV/0!
17 Funds from Other Sources 804174.00 894,271 .00 967 679.00 8.21 %
16 Reserve Funds Used for Operating 19 500.00 10 000.00 0.00 0100.0004
19 In-Kind Donations (Not included In total) 29 826.00 25 000.00 93 489.00 273.96%
20 TOTAL 923r674.00 1 031 771 .00 1 100 679.00 6.687/6
EXPENDITURES
21 Salaries 574 583.00 660 815.00 687 771 .00 4.08%
22 FICA 43 955.00 5055200 52 615.00 4.087/6
23 Retirement 24 048.00 26 000.00 3195400 22.90%
24 Life/Health 50 957.00 64 715.00 68 891 .00 6.450to
25 Workers Compensation 11400.001 lllli2,500.00 9190 .00 296. 12%
26 Florida Unemployment 800. 00 21000.00
1 ,200.00 40.00%
27 Travel-Daily 20p721 .00 12 161 .00 19P000.00 56.24%
28 Travel/Conferenceslfr Ilnlng 67156.00 12,724.00 11000.00'
-13. 55%
29 Office Supplies 70827.00 59419.00 10 000.00 84.54%
30Tele hone 13P475.00 13,958.00 13 950.00 -0.06%
31 Postage/Shipping49470.00 kiiiiii, 79384.00 8 000.00 8.34%
32 Utilities 4141 .00 450000 71000.00 55.56%
33 Occupancy (Building & Grounds) . 21 720.00 30 677.001 111111, 34 618.00 12.85%
34 Printing & Publications 7 899.00 51919.00 51900.00 -0.32%
35 Subscrition/Dues/Membershi s 61000.00 642800 61500.00 1 . 12%
36 Insurance 2169.00 19600,00 49500.00 181 .25%
37 E ui ment:Rental & Maintenance 5105.00 927100 91271 .00 0.00%
38 Advertising10 367.00 300.00 300.00 0.00°/6
39 Equipment Purchases:Ca ital Expense 3p745.00 1035000 10 530.00 1 . 74%
40 Professional Fees (Legal, Consulting) 36 780.00 5 200.00 61000.00 15.38%
41 Books/Educational Materials 29490.00 19418.00 2 000.00 41 .04%
42 Food & Nutrition 0.00 0.00 0.00 #DIV/01
43 Administrative Costs 26,297.00 59,546. 00 5954600 0.00°/6
44 Audit Expense 10 500.00 12 800.00 1450000 13.28%
45 Specific Assistance to Individuals 21452.001 700.00 20000illimmmmmmmmmm0 185.71 %
46 Other/Miscellaneous 14 591 .00 13 500.00 131l500.00 0.00%
47 Other/Contract 21 ,000.00 10 900.00 10 100.00 -7.34%
48 TOTAL 923 648.00 110319337.00 1100549.00 6.71 %
49 REVENUES OVER/ UNDER EXPENDITURES 26.00 434.00 130.00 -70. 05%
17
IRCH My Stan Casktl . Me.
HealtIy Fa Inz - IRC
° SOCC-CSAC 2W4L5 Gant
UNIFORM GRANT APPLICATION
TOTAL PROGRAM BUDGET
FY 2004-05
AGENCY/PROGRAM NAME : IRC HealthyStart Coalition , Inc. - Healthy Families - IRC
FY 02/03 FY 03/04 FY 04/05 % INCREASE
FYE 7/1/02 - 6/30/03 FYE_7/1/03 IN 6/30/04_ FYE_7/1 /04 - 6/30105_ CURRENT VS.
NEXT FY BUDGET
A B C D
ACTUAL TOTAL PROPOSED (col. C-Col. Bycol. B
REVENUES BUDGETED BUDGETED
1 Children 's Services Council-St Lucie 0. 00 #DIV/0!
2 Children's Services Council-Martin 0. 00 #DIV/0!
3 Advisory Committee-Indian River 40 000.00 55 000.00 55 000.00 0.00%
4 United Way-St. Lucie County
5 United Way-Martin County
0.00 #DIV/0!
0. 00 #DIV/0!
6 United Way-Indian River County0.00 #DIVlO!
7 Department of Children & Families 0.00 #DIV/01
8 County Funds 0.00 #DIV/01
a Contributions-Cash 225.00 0. 00 #DIV/0!
10 Program Fees 0.00 #DIVlO!
11 Fund Raisin Events-Net 0.00 #DIV/0!
12 Sales to Public-Net 0.00 #DIV/01
13 Membership Dues 0.00 #DIV/Oi
14 Investment Income 0.00 #DIV/01
15 Miscellaneous 0.00 #DIV/0!
16 Le acies & Bequests 0.00 #DIV/01
17 Funds from Other Sources HF Florida + JICSL 293 709.00 443 985.00 443 985.00 0.00%
18 Reserve Funds Used for Operating 0.00 #DIV/01
18 In-Kind Donations (Not Induded In total) 75r131 .00 71 229.00 63 489.00 .10.87%
20 TOTAL 333 934.00 498 985.00 498 985.00 0.00%
EXPENDITURES
21 Salaries 214 411 .00 298 821 .00 319 054.00 6.77%
22 FICA 16158.00 22 860.0024 408.00 6.77%
23 Retirement
%462.001 12 000.00 1300000 8.33%
24 Life/Health 14 913.00 21v480.00 2142000 -0.28%
25 Workers Compensation 3y087.00 4303.00 4 594.00 6.76%
26 Florida Unemployment 0.00 0. 00 0.00 #DIV/0!
27 Travel-Dail 9 286. 00 10 724.00 12 528.00 16.82%
28 Travel/Conferences/Training 4y614.00 """""
31000.0 1 0 3 000. 00 0.00%
29 Office Supplies 21807.00 32000.00
300000 0.00%
30 Telephone 4 854.00 7 236.00 71200.00 -0.50%
31 Postage/Shipping 559.00 11000.00 12000.00 0.00%
32 Utilities
2p359.00 4,677.00 39656. 00 -21 .83%
33 Occupancy (Building & Grounds 14 400.00 19 437.00 22 812.00 17.36%
34 Printing & Publications 505.00 400. 00 300.00 -25. 00%
35 Subscription/Dues/Memberships 181 .00 850.00 0. 00 -100.00%
36 Insurance 2129.00 2y500,00 29500.00 0.00%
37 E ui ment:Rental & Maintenance 1 ,011 ,00 4P350,00 29208.00 49.24%
sa Advertising25.00 29500.00 1 1000.00 60.00%
39 Equipment Purchases: Capital Expense 498.00 87350.00 200000 76.05%
40 Professional Fees (Legal, Consulting) 10336.00 7r000.00 21812.00 -59.83%
41 Books/Educational Materials 174.00 619.00 900.00 45.40%
42 Food & Nutrition 0.00 0.00 0.00 #DIV/o!
43 Administrative Costs 19 297.00 44 398. 0044 398.00 0.00%
44 Audit Expense 11336,00 49000.00 4 000.00 0.00%
45 Specific Assistance to Individuals 1 345.00 1619.00 0.00 100.00%
46 Other/Miscellaneous 768.00 59700. 00 570.00 90.00%
47 Other/Contract 89128.00 21600. 00 -68.01 %
48 TOTAL 325 515.00 4989952.00 498 960.00 0.00%
49 REVENUES OVER/ UNDER EXPENDITURES 8 419.00 33.001 25.00 -24.24%
18
IRC Healthy Start Coalition, Inc. -
• Healthy Families - IRC
BOCC-CSAC 200405 Grant
UNIFORM GRANT APPLICATION
FUNDER SPECIFIC BUDGET
PROGRAM EXPENSES
2004-05
AGENCY/PROGRAM NAME : IRC Healthy Start Coalition , Inc. - Healthy Families - IRC
FUNDER : A B c
FY 04/05 FY 04/05 % OF
TOTAL FUNDER TOTAL VS,
PROGRAM SPECIFIC FUNDER REQUEST
EXPENDITURES BUDGET BUDGET (col. B/col. A)
21 Salaries 319,054.00 51 ,091 .00 16w01 %
22 FICA 24,408 .00 39908.46 16 , 01 %
23 Retirement 13 ,000 . 00 0 .00 0 .00 %
24 Life/Health 211420 .00 0. 00 0.00 %
25 Workers Compensation
40594,00 0 . 00 0 . 00 %
26 Florida Unemployment 0 .00 0 . 00 #DIV/0 !
27 Travel -Dail 12 ,528.00 0 .00 0 .00 %
28 Travel/Conferences/Training39000.00 0 .00 0 .00 %
29 Office Supplies 31000 .00 0 . 00 0.00%
30 Telephone 7 ,200 .00 0 . 00 0 .00 %
31 Postage/Shipping 11000 .00 0 . 00 0 . 00 %
32 Utilities 31656 .00 0 . 00 0 . 00 %
33 Occupancy Building & Grounds 22 , 812 .00 0 . 00 0 . 00 %
34 Printing & Publications 300 .00 0 .00 0 .00 %
35 Subscri ption/Dues/Memberships 0 . 00 0 .00 #DIV/01
36 Insurance 29500 . 00 0 . 00 0 .00 %
37 Equipment: Rental & Maintenance 29208 . 00 0 . 00 0 .00 %
38 Advertising 19000.00 0 , 00 0 .00 %
39 Equipment Purchases : Ca ital Expense 2 ,000 . 00 0 . 00 0 . 00 %
40 Professional Fees ( Legal , Consulting ) 21812 .00 0. 00 0 . 00%
41 Books/Educational Materials 900 .00 0 .00 0 . 00 %
42 Food & Nutrition 0 .00 0 . 00 #DIV/01
43 Administrative Costs 44,398 .00 0 . 00 0 .00 %
44 Audit Expense 49000 . 00 0 . 00 0 . 00 %
45 Specific Assistance to Individuals 0 . 00 0 . 00 #DIV/01
46 Other/Miscellaneous 570 . 00 0 . 00 0 .00 %
47 Other/Contract 2 ,600 . 00 0 . 00 0 . 00 %
48 TOTAL $498 , 960 . 00 $ 547999 . 46 11 . 02 %
19
." . IRC He&VW Slag Cod6on. Ps.
Herlihy Famlim . IRC
t
BOCC-CSAC 2001-05 Gren1
UNIFORM GRANT APPLICATION
EXPLANATION FOR VARIANCES OF 15% OR MORE
TOTAL PROGRAM BUDGET
AGENCYIPROGRAM NAME: IRC Healthy Start Coalition, Inc. - Healthy Families - IRC 2004-05
FUNDER : IRC Board of County Commissioners - Children's Services Advisory Committee
UNE ITEM EXPLANATION FOR VARIANCE
#DN/01
#DN/01
#DN/01
#DN/01
#DN/01
#DN/01
#DN/01
#DN/01
#DN/01
#DN/01
#DN/01
#DN/01
#DN/01
#DN/01
#DN/01
#DN/el
#DIV/0l
The HF-IRC program added two FSW positions and one halt time Supervisor and half time FAW position in 2003-04. Travel was
budgeted lower in 2003-04 due to the time factored in hiring the additional positions and getting a case load large enough to bring on
Travel-Daithe new positions, which were hired during the fiscal year. The 2004-05 HF-IRC program is fully staffed, with those addtional positions
factored in for the increase in travel expenses.
The additional rent factors in an annual increase for yearly rent as well as the increase in HF-IRC staff, where the rent is divided
by the
Occu anc (Building & Grounds CASTLE staff using the building , based of a square feet calculation for 2004-05.
In 2003-04, the HF-IRC was told they would receive additional TANF funds in October of 2003. Due to these expected funds, the HF-
IRC budget for this line item was purposely kept low knowing that additional TANF funds could be used for this line item. At this point
in
Books/Educational Materials time, no TANF funds are expected for 2004-05, so the increase in this fine item factors in the lack of TANF fundino
difference.
#DIV/01
20
. _" .. . RO Hedlhy Start Coakion, hx.
. Hearty FanV%s • IRC
• 130CCCSAC 2004-05 brant
UNIFORM GRANT APPLICATION
EXPLANATION FOR VARIANCES OF 15% OR MORE
FUNDER SPECIFIC BUDGET
AGENCY/PROGRAM NAME: IRC Healthy Start Coalition, Inc. = Healthy Families - IRC
FUNDER : IRC Board of County Commissioners - Children's Services Advisory Committee
LINE ITEM EXPLANATION FOR VARIANCE
Salaries
The HF-IRC program added two FSW positions and one half time Supervisor and FAW position in 2003-04, which were hired
throughout the fiscal year. The Increase in salary factors in these additional sitions, which are in lace for the u omin
fiscal ear.
The HF-IRC program added two FSW positions and one halltime Supervisor and halltime FAW position in 2003 04. The increase in
FICA FICA factors in the additional salary for these positions, which are in place for the yocomina fiscal year.
#DN/01
#DN/01
#DN/ol
#DN/01
i
21
r
�S�P�T Cpq��T
1603 10th Avenue
Vero Beach , Florida 32960
2 (772) 563 - 9118 Fax (772 ) 563 - 9125
o e- mail : irchsc@aol . com
AV L
May 26, 2004
IRC Board of County Commissioners - Children's Services Advisory Committee
Attn: Joyce Johnston-Carlson, Director - IRC Human Services
1900 27th Street
Vero Beach, Florida 32960
Dear Joyce and Review Panel,
On behalf of the IRC Healthy Start Coalition and its Board of Directors, I would like to respectively submit our grant
applications for the TLC Newborn and Healthy Families - IRC programs. The grant amount requested for the FY
2004-2005 for both programs is the same amount received for 2003 -04 . The core funding for the HF-IRC program,
which the BOCC-CSAC funding is crucial to help bring to our community, is $443 ,985 and from the Florida Ounce
of Prevention - Healthy Families Florida. The $55 ,000. 00 sought from the BOCC - CSAC represents 12 .4% of the
mandatory 25 .0% local match for the Healthy Families - IRC program. This match provides a great investment not
only for at-risk families in Indian River County, but also in terms of bringing dollars and jobs to our community.
On-going accomplishments have been achieved with both programs in 2003 -04 . For the Healthy Families program,
eight of the families that started in the program several years ago graduated this summer. This "graduation" means
that the families in the program have met all their family's goals and progressed up the HF levels towards optimal
family functioning and parent/child interaction. Of these eight families, seven were employed and two have in-
creased their level of participation. Before entering the program, six were unemployed. The HF-IRC program has
also rebounded remarkably well from staffing changes that occurred last fall. The TLC Newborn program continues
to serve 96% of all newborn families and serves as the cornerstone for brain development and has served 6,000 babies
and families since its inception. Both programs are successfully working on parenting and mental health/wellness
with the families they serve in order to promote parent/child interaction and help build development of the infants'
and children' brain in their crucial fust. three years in order to prosper once the child enters school.
Thank you for reviewing the IRC Healthy Start Coalition's TLC Newbom and Healthy Families - IRC grant applica-
tions . I look forward to the opportunity of presenting our proposals in June. On behalf of the 1 ,000 families of
newborns that the TLC Newborn Program and over 180 families the Healthy Families - IRC program serve, thank
you for your continued support.
;Sincerely,
cott Josep , M. S .
Executive Director
The Mission of the Indian River County Healthy Start Coalition is to establish a system that guarantees all women
have access to prenatal care and that all infants have access to services that promote normal growth and development.
2004 CHILDREN ' S SERVICES ADVISORY COMMITTEE
REQUEST FOR PROPOSAL ( RFP )
# 5054
IRC PURCHASING DIVISION
262519TH AVENUE
VERO BEACH, FLORIDA 32960
PHONE 772-567-8000 EXT. 1461
FAX 772=770=5140
Indian River County Healthy Start Coalition , Inc .
1603 10th Avenue
Vero Beach , - Florida 32960
( 772 ) 563 -9118 ( 712 ) 563 - 9125 (fax)
irchsc@aol . com
D . Scott Joseph , Executive Director
Jean Anderson , Board President
2004 -2005 Grants for :
Healthy Families - IRC Program
TLC Newborn Program
NOT FOR PROFIT AGENCY CERTIFICATION
The County of Indian River requires , as a matter of policy, that any Consultant or
firm receiving a contract or award resulting from the Request for Qualifications
issued by the County of Indian River, Florida , shall make certification as below.
Receipt of such certification , under oath , shall be a prerequisite to the award of
contract and payment thereof.
I (we ) hereby certify that if the contract is awarded to me , our firm , partnership , or
corporation , that no members of the elected governing body of Indian River
County, nor any professional management, administrative official or employee of
the County, nor members of his or her immediate family, including spouse ,
parents , or children , nor any person representing or- purporting to represent any
member or members of the elected governing body or other official , has solicited ,
has received or has been promised , directly or indirectly, any financial benefit,
including but not limited to a fee , commission , finder's fee , political contribution ,
goods or services in return for favorable review of any Proposal submitted in
response to the Request for Qualifications or in return for execution of a contract
for performance or provision of services for which Proposals are herein sought.
The undersigned certifies that he/she is a principal or officer of the firm applying
for consideration and is authorized to make the above acknowledgments and
certifications for and on behalf of the applicant .
The undersigned certifies that the Applicant has not been convicted of a public
entity crime within the past 36 months , as set forth in Section 287 . 133 , Florida
Statutes .
Failure to sign this form will result in disqualification
Handwrltt Ignature of Authorized Principal(s) : DATE : � C3 ;Z
NAME
TITLE oard President
NAM' OF FIRM/PARTNERSHIP/CORPORATION :
Indian River County Healthy Start Coalition Inc
Sworn to and subscribed to FOR AND ON BEHALF OF THE APPLICANT:
me a Notary Public, this
�y of , 2004 . BY:
RENOtDD083460
a MY cokimlSSIa� RES: Fe(SEAL) (TYPE NAME & TIT NOTAFW fi N=y Sw
Indian River Board of County Commissioners
1840 25th Street
Vero Beach , FL 32960
X
AUTHORIZATION FOR RELEASE OF INFORMATION
Indian River County and IRC Healthy Start Coalition Inc (Agency/Individual are
in the process of negotiation of a contract for Healthy Families — IRC and the
TLC Newborn Program . Indian River County is authorized to make an
investigation of the Agency/Individual regarding its experience and qualifications .
The Agency/Individual authorized the release of all relevant information
concerning prior services furnished , contracts and background information of the
Agency/Individual . The Agency/Individual authorizes any individual or
organization that is in possession of relevant factual contract and background
information , to release such data to Indian River County in response of the
County's request.
When an individual employee of the Agency signs Authorization for Release of
Information , such individual authorizes the County to obtain relevant background
information concerning such employee ' s criminal record , if any, and such other
information that may be relevant to employee' s good character and work
experience .
Authorization is given here by the Agency/Individual and such employees who
execute this authorization with the understanding and limitation that Indian River
County will utilize the information obtained for the purposes set forth herein and
that such information shall not be disclosed to third parties except as provided by
law.
Name Agency/Individual Indian River County Healthy Start Coalition Inc
Print name
Name Employee Providin authorization Jean Anderson
' Pr' t name
Signature (in blue ink) a
Date 4= 2 , 05
XI
SWORN STATEMENT UNDER SECTION 105 . 08 ,
INDIAN RIVER COUNTY CODE , ON DISCLOSURE OF RELATIONSHIPS
THIS FORM MUST BE SIGNED IN THE PRESENCE OF A NOTARY PUBLIC
OR OTHER OFFICER AUTHORIZED TO ADMINISTER OATHS ,
1 . This sworn statement is submitted with RFP No . 6067 for Healthy Families —
IRC and the TLC Newborn Program
2 . This sworn statement is submitted by: Jean Anderson
Indian River County Healthy Start Coalition Inc .
(Name of entity submitting Statement)
whose business address is :
1603 10"' Avenue Vero Beach FL 32960 and
(if applicable )
its Federal Employer Identification Number ( FEIN ) is 6503 63 222
( If the entity has no FEIN , include the Social Security Number of the individual
signing this sworn statement
3 . My name is Jean Anderson
( Please print name of individual signing )
and my relationship to the entity named above is Board President
4 . 1 understand that an "affiliate" as defined in Section 105 . 08 , Indian River
County Code , means :
The term "affiliate" includes those officers , directors , executives , partners ,
shareholders , employees , members , and agents who are active in the
management of the entity.
5 . 1 understand that the relationship with a County Commissioner or County
employee that must be disclosed as follows :
Father, mother, son , daughter, brother, sister, uncle , aunt , first cousin ,
nephew, niece , husband , wife , father- in- law , mother- in -law, daughter-
XII
in -law, son -in -law, brother- in -law, sister-in - law, stepfather, stepmother,
stepson , stepdaughter, stepbrother, stepsister, half brother, half sister,
grandparent , or grandchild .
6 . Based on information and belief, the statement, which I have marked below is
true in relation to the entity submitting this sworn statement. [Please indicate
which statement applies .]
X Neither the entity submitting this sworn statement, nor any officers ,
directors , executives ,. partners , shareholders , employees , members , or
agents who are active in management of the entity, have any relationships
as defined in section 105 . 08 , Indian River County Code , with any County
Commissioner or County employee .
The entity submitting this sworn statement, or one or more of the officers ,
directors , executives , partners , shareholders , employees , members , or
agents , who are active in management of the entity have the following
relationships with a County Commissioner or County employee :
Name of Affiliate _Name of County Commissioner Relationship
or enti or employee
XIII
(signature )
ly
(date )
STATE OF VJ CK 1 (7 Q
COUNTY OF '�a��� �px
The foregoing instrument w s acknowled ed before me thisQas of
2004 b y
y , who is personally
known t e or who has produced _P(or) %Ptt Va. as
identification .
NOTAR P BLIC
SIGN :
PRINT: y
State of Florida at Large COX
g � MY COMMISSION I DD083g60
My Commission Expires : !;OFf/ EXPIRES: Febmary' 23, 20MMS
1400-3-NOTARY FL Notary Samoa i Dw r,& kX
(Seal )
XIV
t .
Organization : Indian River County Healthy Start Coalition, Inc. Program: Healthy Families — IRC Program
Funder: IRC Board of County Commissioners — Children 's Services Advisory Committee - 2004 Grant Application
ORGANIZATION : Indian River Healthy Start Coalition Inc
PROGRAM : Healthy Families - Indian River County
TABLE OF CONTENTS
Please "X" the parts of the grant application to indicate that they are included. Also, please put the page number where the information
can be located.
X Section of the Pro osalPa e # llI
x TABLE OF CONTENTS (check list) 1
x COVER PAGE (with signatures),
A. ORGANIZATION CAPABILITY (one page maximum)
x 1 . Mission and Vision of organization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . 4
x 2 . Summary of expertise, accomplishments, and population served , ISO * 9 gel * * * 4
B. PROGRAM NEED STATEMENT (one page maximum)
x 1 . Program Need Statement . , . . . . . . , , , , , 00 * 00 , 5
x 2 . Programs that address need and gaps in service . , . . * SO ISO Igoe 5
C. PROGRAM DESCRIPTION (two pages maximum)
x 1 . Funding priority. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
x 2 . Description of program activities , 1 6
. . . . . . . . . . . . . . . . . . . . . .
x 3 . Evidence that program strategy will work . . . . . . . . . . . . . . . . . . . . . . . . .
x4 . Staffing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . 7
. . . . . . . . . . . . . .
x 5 . Awareness of program . . . . . . . . . . . . . . . . . . . . . . . . . . . .
x 6 . Accessibility of program . . . . . . . . . . . . . . . . . . . . . . . .
x D. MEASURABLE OUTCOMES (two pages maximum) . . . . . . . . . . . . . . . . . . . . . . . . . 8
x E. COLLABORATION (one page maximum) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
9
F. PROGRAM EVALUATION (two pages maximum)
x1 . Demographics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
x2 . Measures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . 10
. . . . . . . . . . . . . .
x 3 . Reporting , , 1 0 , 0 0 IS , 0 # , , 0 0 SO 0 0 , 4 , 0 IS , 4 , 0 0 IS , 0 0 9 0 0 0 10
x G. TIMETABLE (one page maximum) * * too 09006 11
A. UNDUPLICATED CLIENT COUNT
X L. Projections by Location . , . , , , , 12
. . . . . . . . . . . . . . . . . . . . . .
x 2 . Projections by Age Group . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . 9 0 0 0 . . . . . . . 12
1
Organization: Indian River County Healthy Start Coalition , Inc. Program: Healthy Families — IRC Program
Funder: IRC Board of County Commissioners — Children 's Services Advisory Committee - 2004 Grant Application
I. BUDGET FORMS
x 1 . Financial Budget Forms. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . 13
x J. FUNDER SPECIFIC/ADDITIONAL SHEETS NA
x K. APPENDIX 22
2
EXHIBIT B
[From policy adopted by Indian River County Board Of County Commissioners on February 19 ,
2002]
" D . Nonprofit Agency Responsibilities After Award of Funding
Indian River County provides funding to all nonprofit agencies on a reimbursement basis
only.
All reimbursable expenses must be documented by an invoice and/or a copy of the canceled
check . Any expense not documented properly to the satisfaction of the Office of Management &
Budget and/or the County Administrator may not be reimbursed .
If an agency repeatedly fails to provide adequate documentation , this may be reported to the
Board of Commissioners . In the event an agency provides inadequate documentation on a
consistent basis , funding may be discontinued immediately. Additionally, this may adversely
affect future funding requests .
Expenditures may only be reimbursed from the fiscal year for which funding was awarded . For
example , no expenditures prior to October 1st may be reimbursed with funds from the following
year. Additionally, if any funds are unexpended at the end of a fiscal year, these funds are not
carried over to the next year unless expressly authorized by the Board of Commissioners .
All requests for reimbursement at fiscal year end (September 30th) must be submitted on a timely
basis . Each year, the Office of Management & Budget will send a letter to all nonprofit agencies
advising of the deadline for reimbursement requests for the fiscal year. This deadline is typically early
to mid October, since the Finance Department does not process checks for the prior fiscal year
beyond that point .
Each reimbursement request must include a summary of expenses by type . These summaries
should be broken down into salaries , benefits , supplies , contractual services , etc . If Indian River
County is reimbursing an agency for only a portion of an expense (e . g , salary of an employee) , then
the method for this portion should be disclosed on the summary. The Office of Management &
Budget has summary forms available .
Indian River County will not reimburse certain types of expenditures . These expenditure types are
listed below.
a . Travel expenses for travel outside the County including but not limited to ; mileage reimbursement,
hotel rooms , meals , meal allowances , per Diem , and tolls . Mileage reimbursement for local travel
(within Indian River County) is allowable .
b . Sick or Vacation payments for employees . Since agencies may have various sick and vacation
pay policies , these must be provided from other sources .
c. Any expenses not associated with the provision of the program for which the County has awarded
funding .
d . Any expense not outlined in the agency's funding application .
The County reserves the right to decline reimbursement for any expense as deemed necessary. "
- 1 -
EXHIBIT C
STANDARD TERMS FOR GRANT CONTRACT
1 . Notices : Any notice , request, demand , consent, approval or other communication required or
permitted by this Contract shall be given or made in writing , by any of the following methods
:
facsimile transmission ; hand delivery to the other party; delivery by commercial overnight courier
service; or mailed by registered or certified mail (postage prepaid ) , return receipt requested at the
addresses of the parties shown below:
County: Joyce Johnston -Carlson , Director
Indian River County Human Services
184025 th Street
Vero Beach , Florida 32960-3365
Recipient : Indian River County Healthy Start Coalition , Inc .
1603 10th Avenue
Vero Beach , Florida 32960
Attention : Scott Joseph
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 -
`. - ,INTERNAL REVENUE SERVICE DEPARTiiENT OF THE TREASURY
DISTRICT DIRECTOR
C - 1130
ATLANTA , GA 30301
t
Date. Y -tmP to er
Identificati0 =) f`tua; ber :
APR 2 9 1993 6 5 - 0 2-1 6 332:2 2
Contact Person :
ROBERTA VAN METER
INDIAN iii 3; 'r' e UUi'lTY HEALTIiY START COntact Telephone Nucab ,�
COALITION INC ( 404 ) - 01BF
1900 27TH STREET
VERO BEA Hs ` L 32060
Accounting Period Ending :
June 30
Foundation Status Class if icatit-in :
509 ( a ) ( 1 )
Advance Ruling Period ina. eginsa
No October 23 , 1992
Advance Ruling Period Ends :
June 30 , 1997
Addendum Applies :
Yes
Clear App i icant :
Based on information you supplied , and assuming your op - ra ions ori l i be as
stated in your application for recognition iri eY, emptl •• n , we have determined you
are exempt from federal income tax under section 501 ( x ) of the Internai Re :Tenue
Cede as an organization described in section 501 ( E ) ( 3 ) .
w
Because you are a nEul y created organizations we are not now mak i n a
final determination of your foundation status under section 50� T : a ) of the Code .
However , s-Ie have determined that you can reasonably expect to be a publicly
supported organization described in sections 509 ( a ) ( I ) and 170 ( b ) ( 1 ) ( 1#% ) ( vi ) .
Accordingly , during an advance ruling period YOu will be treated as a
publicly supported organization , and not as a private foundation . This advance
ruling period begins and ends on the dates shoran above .
krithin 90 stays after the end of Your advance ruling period , you must
send us the information needed' to determine whether you have met the require - ,
ments c; f the applicable support test during the advance ruling period . If you
establish that you have been a publicly supported organization , s-} e Wil I cleassi -
fY You as a sectior. 509 ( a ) ( 1 ) or 5097 ( a ) ( 2 ) organization as long as you continue
to meet the requirements of the applicable support test . If you do not meet
the public support requirements during the advance ruling period , we 1-1i 11
classify you as a private foundation for future
peril-. ds . Alsio , if we classify
you as a private foundation , we wi I i treat you as a private foundation frc111i
your beginniz, g date for purposes of section 507 ( d ) . and 4940 .
Grantor and contributors may rely on .. 4r deft? rRilnatlCan that you are not d
pr i ate foundatit„0 until 90 days after t
If �� i ! he end of Slur advanC F? ruling period .
Y send us the required informa +' Iain :within the 90 days ; grantors
r 3 . t ' = rs and
contributors may continue to rely on the advance s"- terrainatiCIII UT, Fi 1 !ae A) at< _•
a f final determination of yclur foanda ~ ion status .
i
i
ill0' ' AN rUVci:: COUNTY HEALTHY ; =' '
If Ne publish a notice in the .i :: erna1 Reven1 � t: t! tletln statingthat
h+ ' Jle
:d ! 1 no Iongi: r treat you as a putsi ic ? e supported su „ 1 or- ganizatiatc, n : grantors and
contributors may not rely on this determination after the date s-ae publish the
notice . in ddition , if you Io, SC yr
, ur status as a publicly �. uppo, rted or ani —
zat i on , and grantor or contributor was respons i b l e firs or w �
ware Of 1
act or failure to act , that resulted in your loss of such status ,as athat persone
may not rely con this determination from the date of the act or failure to, act ,
Also , if a grantor- or contributor learned !
tpubhat we had it -
s-ryou
o, uld be remf; ved from classification : as a g 'entice that nlicly supporttee d organization
, then
that person may not rely on this determination as of the date he or she
acquired such knowledge .
If you rhange your sources of 5uppo, rt , your Purposes ? character , or imethod
Of operation , please let us know so we can consider the effect of the char: tle on
your exempt status and foundation status . If you amend your organizational
dor. ument or bylasas please send us a copy of the amended dociument or bylasw !; .
Also , let us know all changes in your name or address .
As of January 1 , 1934 , you are liable for social securit ; es taxes under
the Federal Insurance Contributions Act on amounts of $ 100 Or more you pay to
each of your employees during a calendar year . You are not liable for the tax
imposed under the Federal UnempIoyment Tar, Act ( FUTA ) .
Organizations that are not + -
priva .. e foundations are not subject to, the pri �,-
vate foundation excise taxes under Chapter 42 of the Internal Revenue Code .
HoHever , you are not automat i ea ! ! v exempt fro- o i
iii th =. r federal e ). r_ i = e tax; eMU If
you have any questions about excise , eniplr_, yment , or other- federal taxes , please
let us kno, s-r .
Donors may deduct contributions to you as provided in section 170 of the
Internal Revenue Code . Bequests , legacies , devises , transfers or gifts t (-, you
or for your t+ se are deductible for Federal estate and gift tax purposes if they
meet the applicable provisions of sections 20557 21061 and 2522 of the Co, dev
Donors may deduct contr- itxutions to you only to the extent that their
contributions are gifts , with no consideration rec +_ ived . Ticket purchases and
similar payments in conjunction with fundraising events may not necessari ; 0 ,
qualify As deductible contributions , depending con the circunrstances , Re �teiiue
Ruling 67 - 246 , published in Cumulative Bulletin 1967 - 2 , on
schen taxpayers page 1gives
guidelines regarding7
p yer- s esay deduct payments for admission taor -
ether participation in , fundraising activities for charity .
You are not required to
fi Ie Form 9901 Return of Organization Exnp : -
r = mIncome _ a ): , f your gross receipts each year are
normally 25you recei000 or less . If package
in the mail , simply attach the label provided ,
check ntr► aIIhe bFx; in the Beading to indicate that your annual gross riceipis are
Y , 5 , ? 00 or less , and sign the return ,
If you .% re required to file a return you nliist t I le it te ;/ the iF, t !) tja 'J :If
Letter ( jll � ' 1� 1 ',
� E �
T
_ .SEP, NTfil
th }- fifth mon =- h after the And or' your annual accounting period. she charge.
penalty of $ 10 a day when a return i s f i I ed l ate 7 un i ess them i s rea _ nab l e
cause for the delay . rioi-rever 7 the maximum penalty 3i +e charge cannot exreed
$57000 or 5 percent of your gross receipts for the year , whichever is less . We
may also charge this penalty if a return is not complet- . S „ 7 please be sure
_
your return is comp Iete before yc,y file it .
You are not required to file federal income toy returns unless you arra
subject to thea tax on unrelated business income under section 511 of the Code .
If you are subject to this tax , you must f i le an income tar, return on Forel
990-T7 Exempt Organization BusinessIncome Tax Return . In this letter we erre
not determining whether any of yoter [ resent or proposed activities are unre -
lated trade '-ar business as def i tied in section 513 of the Code .
You need an employer identification number even if you have no empfoy _•es .
If an employer identification number was not entered on your application ? we
i-ii i I assign , number to you and advi - e you of it . Please use that number' on
all returns you file and in all correspondence i-lith the Internal Revenue
Service .
If we said in the heading cif this letter that an addendum applie= s the
addendum enclosed is an integral part of this letter .
Because this letter could help us resolve any quAtions about yqur exempt
status and foundatioin status7 you should keep it in Your permanent records ,
If you have any questions ? please Contact the person whose name end
telephone number are shown in the heading of this letter .
S-iycerely yours ?
AMA
_ Paul k1ifliamas
- district Director
Enc Iosure ( s ) :
Addendum
Form 872- C
5
11 / 04 / 2004 14 : 42 7727704580 PAGE 01
A. C DATE (OV 4DrrYYY)
TM. CERTIFICATE OF LIABILITY INSURANCE Novao4
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
SID SANACK INSJA Hil_8 ROGAL & HOBBS CO. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
04614TH AVE. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
2
2 0 BOX A ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
30
VERO BEACH FL 32961 INSURERS AFFORDING COVERAGE I NAIC #
INSURED INSURER A: AUTO-OWN COMPANY_ __ _.. _
- - -- —
INDIAN RIVER COUNTY HEALTHY START, INC. ! INSURER B,. HARTFORD UNDERWRITERS INSURANCE COMPANY
1603 10TH AVE.
INSURER C;
VERO BEACH FL 32980 - ' -
I 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 ALLTHE TERMS. EXCLUSIONS AND CONDITIONS OF
SUCH
POLICIES. AGGREGATE LIMITS SHOWNMAY HAVE BEEN REDUCED BY PAID CLAIMS.
- _.. . .. . _ ... . . - - � . ... FFECTNI' rPO+JCY �.I� LIMITS
TYPE OF INSURCE POLICY NUMBER
LTR ANIMAMPMMp
GENERAL LWBILITY 93-211127-00 MAR 10 04 MAR 10 05 I EACH OCCURRENCE__. , $ 1 ,000, 00
- I I t-DAMAGE To rErmo rt 50 ,000
�X COMMERCIAL GENERAL 11ABIL1� I ! -
- - L - • ._ a r. EXP (Any one person) S 5,000
1 I CLAIMS MADE( X I OCCUR
IPERSONALA ADV INJURY , i Included
1
A ! I . -� .. — • _ — - - I I GENERAL AGGREGATE � s 1 ,000,000
! I I PRODUCTS-COMP1.OF AGG• ; _ 1 ,000,000
— .E IT APPLIES PER I _.
GEN L AGGREGATE LIMIT _. .
I POLICY I I PROLQci
AUTOMOIMLE LIABILITY I 93-211 -127.00 i MAR 1004 I MAR 10 OSi COMBINED
BII aEDSINGLE LIMIT I s 1 ,000,000
1 ANYAUTO I - -INJURY-
ALL OWNED AUTOS I I BODILY
I I I I (Per person) � s
' r 11I SCHEDULED AUTOS -•- •
A FX
I HIREDAUTOS I I I BODILY
Dacddont)RY Is
X I NON-OWNED AUTOS I {-•- -
. I
PROPERTY DAMAGE S
PerooddeM
GARAGE LIABILITY I I I AUTO ONLY - EA ACCIDENT I i
I ANY AUTO I OTHER THAN EA ACC ' S
-._ I AUTO ONLY: --- S —
EXCESS I UMBRELLA LIABILITY I EACH OCCURRENCE - S
I - �! OCCUR r -, CLAIMSMADE I I ( AGGREGATE IS
L s
. » DEDUCTIBLE
! I RETENTION S I s
WORKERS COMPENSATION AND 21 WEC GD7700 MAY 3 04 MAY 3 06 (VVC $T� " U. ; °T"ea
EMPLOYERS' LIABILITY
B IAM/ PRGPRET0WPARTIIEFMXE1MVE I I I_E.L. EACH ACCIDENT -S 100,000
OFFICER MEIMMR EXCLUDED? I , E.L. DISEASE-EA EMPLOYEEI s 1001000
._- . .--
spP.CtALPROVISION% W" I E.L, DISEASE-POLICYLMAIT Is 5001000
( OTHER:
DESCRIPTION OF OPERATIONS/LOCATIONSIVEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS
CERTIFICATE HOLDER IS ALSO NAMED AS AN ADDITIONAL INSURED WITH REGARDS TO COMMERCIAL GENERAL LIABILITY COVERAGE,
ALSO NOTE 10 DAYS NOTICE OF CANCELLATION FOR NONPAYMENT OF PREMIUM
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF. THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 30
DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT
FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE
INDIAN RIVER COUNTY BOARD OF INSURER, ITS AGENTS OR REPRESENTATIVES.
COUNTY COMMISSIONERS
184025TH ST AUTHORIZED REPRESENTATIVE f] Q
Yoe"
p
VERO BEACH, FL 32960 d Yoe
Attention : JOYCE JOHNSTON-CARLSON IChele N . Poysell
ACORD 25 (2001 /08) Certificate # 81924 O ACORD CORPORATION 1988
NON PROFIT PROFESSIONAL LIABILITY POLICY
RENEWAL CERTIFICATE
Please attach this Renewal Certificate to Your eXDiring Policy ,
UNITED STATES LIABILITY
INSURANCE COMPANY
WAYNE, PENNSYLVANIA
In consideration of the renewal premium stated below, expiring Policy Number ND01005544E is renewed
for the Policy Period stated below. The Company will issue a complete copy of this Policy upon receipt of
a written request from the Insured .
The New Policy Number is ND01005544F .
The Application ( if any) for this renewal , and all previous Applications made to the Company for this
insurance , including any material submitted therewith , shall be made a part of this Renewal Policy as if
physically attached hereto . PLEASE REFER TO YOUR POLICY FOR THE DEFINITION OF
"APPLICATION . "
POLICY DECLARATIONS
ITEM I . PARENT ORGANIZATION AND PRINCIPAL
Indian River County Healthy Start Coalition , Inc.
1603 10th Avenue
Vero Beach , FL 32960
ITEM II , POLICY PERIOD : (MM/DD/YYYY)
FROM $/$/2004 TO . 8/$/2005 12 :01 AM STANDARD TIME AT
YOUR MAILING ADDRESS SHOWN
THIS POLICY CONSISTS OF THE FOLLOWING COVERAGE PARTS FOR WHICH LIMITS OF LIABILITY ARE INDICATED .
Coverage Part A. Non Profit Directors and Officers Liability
ITEM III . LIMITS OF LIABILITY: $ 1 , 000 , 000 EACH CLAIM
Not Covered FIDUCIARY LIABILITY LIMIT
$ 1 , 000 , 000 IN THE AGGREGATE
ITEM IV. RETENTION : $ 0 EACH CLAIM
ITEM V. PREMIUM : $ 1 ,218
Coverage Part B . Employment Practices Liability
ITEM III , LIMITS OF LIABILITY: $ 1 ,000 , 000 EACH CLAIM
$ 1 , 000, 000 IN THE AGGREGATE
ITEM IV. RETENTION : $ 0 EACH CLAIM
ITEM V. PREMIUM : $ 343
ITEM VI . Coverage Forms Parts and Endorsement(s -made a part othis policy at time of issue :
DNOTIC ( 12-02) Discl. Notice of Terrorism Insurance Coverage USL-DOJ (04-00) Policy Jacket
DO- 100 (04-00) Coverage Part A
DO- 101 (04-00) Coverage Part B
DO-209 (01 -94) General Professional E & 0 Excl. Endt
DO-273 (04-02) Fair Labor Standards Act, Exclusion
DO-275 ( 11 -02) Coverage Clarification Endt
DO-FL (07-01 ) Florida State Amendatory Endt
Endorsements in bold have been added to the policy or have a new edition date and are attached with this certificate.
Agent : AGENCY MARKETING SERVICES , INC . [1004] By
Date Issued : 8/5/2004
Authorized Representativ
USL-DOD CERT ( 11 /97)
1603 10th Avenue
Vero Beach , Florida 32960
} (772) 563- 9118 Fax (772) 563 - 9125
0 2 e- mail : irchsc@aol . com
IV G0
Oct. 15 , 2004
IRC Board of County Commissioners —
Children ' s Services Advisory Committee
Attn: Joyce Johnson-Carlson, Director
IRC Human Services
1840 25th Street
Vero Beach, Florida 32960-3365
Dear Joyce,
Enclosed is the following :
Signed contracts for ' 04- ' 05 grants
Insurance liability statement
501 C3 letter status
Letter explaining transportation of clients
The programs that are partially funded by the BOCC- CSAC for 2004- 05 , which are
Healthy Families — IRC and the TLC Newborn do not transport clients in their personal
vehicles nor is their company vehicles provided for transportation of clients .
Sincerely,
D . Sc o t4,
,
Executive Director
The Mission of the Indian River County Healthy Start Coalition is to establish a system that guarantees all women
have access to prenatal care and that all infants have access to services that promote normal growth and development.