HomeMy WebLinkAbout2006-331W. r e a
INDIAN RIVER COUNTY
GRANT CONTRACT
This Grant Contract ("Contract") entered into effective this -�day of October 2006, by and
between Indian River County, a political subdivision of the State of Florida ; 1840 251h Street, Vero
Beach , Florida, 32960-3365; and Boys & Girls Clubs of Indian River County, Inc. , (Recipient) , of:
Boys & Girls Clubs of Indian River County, Inc.
P .O. Box 643068
Vero Beach , Florida 32964
South County Branch
Background Recitals
A. The County has determined that 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 proposal 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
(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 the 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
2006/2007 ("Grant Period"). The Grant Period commences on October 1 , 2006 and ends on
September 30, 2007.
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4 . Grant Funds and Payment. The approved Grant for the Grant Period is : THIRTY
THOUSAND , DOLLARS ($30,000). The County agrees to reimburse the Recipient from such
Grant funds for actual documented costs incurred for the 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 Obliqation 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 to written notice.
5.2 . Compliance with Laws. The Recipient shall comply at all times with all applicable
federal , state , and local laws and regulations .
5 . 3 . Quarterly Performance Reports . The Recipient shall submit quarterly, cumulative ,
Performance Reports to the Human Services Department of the County, within fifteen
( 15) business days following : December 31 , March 31 , June 30 and September 30 .
5.4 . Audit Requirements . If Recipient receives $25, 000 , or more in 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 the prior fiscal year is past due and has
not been submitted by May 1 .
5 .4. 1 .The Recipient further acknowledges that, promptly upon receipt of a qualified
opinion from its independent auditor, such qualified opinion shall immediately be
provided to the Indian River County Office of Management and Budget. The
qualified opinion shall thereupon be reported to the Board of Commissioners and
funding under this Contract will cease immediately. The foregoing termination right
is in addition to any other right of the County to terminate the 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 October 21 , 2006 provide to
Indian River County Risk Management Division a certificate, or certificates , issued by an
insurer, or insurers, authorized to conduct business in Florida that is rated not-less-than
Category A- :VII by A.M . Best, subject to approval by Indian River County's Risk
Manager, of the following types and amounts of insurance :
(i) Commercial General Liability Insurance in an amount not less than
$1 ,000,000 combined single limit for bodily injury and property
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damage, including coverage for premises/operations ,
product/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) Worker's 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 the County. In
addition , the County may request such other proofs and assurances as it may
reasonable 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 Worker's 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 COUNTrBOARD OF COMMISSIONERS
� p
By: .
Arthur R. Neuber ` airman
BCC Approved :
Attest: J . K. Barton, Clerk-
By: k L X3
Deputy Clerk
Approved . �
Josep . Baird
aunty Administrator
Approved as to form and legal sufficiency:
By: y'
Marian E . Fell, Assistant C unity Attorney
RECIPIENT-.r-
By:
ECIPIENT:By:
Boys & Girls Clubs of Indian River County, Inc.
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EXHIBIT A
(Copy of complete Request for Proposal )
EXHIBIT - A -
Boys & Curls Club of Indian River County, Inc. — South County Branch
CoW Application to the Children's Services Advisory Committee
PROGRAM COVER PAGE for 2006-2007
Organization Name: Boys & Girls Clubs of Indian River County, hie.
President & CEO: Ronnie Hewett E-mail : RonnieHewettna,BGCIRC.org
Address: P.O. Box 643068 Telephone: 772-299-7449
Vero Beach, Florida 32964-3068 Fax : 772-299-3840
Director of Finance: Heidi Watkins E-mail: HeidiWadcinsna.BGCIRC.org_
Address: P.O. Box 643068 Telephone: 772-299-7449
Vero Beach, Florida 32964-3068 Fax: 772-299-3840
Program Title: South County Branch
Priority Need Area Addressed: Mental Wellness Issues and Childcare Access
Brief Description of the Program: Taxonomy Definition PS-980. 100: Programs that provide a wide
range of supervised recreational activities and delinnguencv prevention services for children and youth
of all ages and backgrounds, but particularly for disadvantaged youth, through membership in boys
and/or girls clubs. Club members are entitled to use recreational facilities and may have access to
counseling, tutorial services. employment assistance, gang programs, drug abuse and alcoholism
prevention and other activities and services that direct their energies toward positive social goals and
facilitate healthy personality development.
SUMMARY REPORT — (Enter Information In The Black Cells Only)
South Count
Amount Requested from Funder for 2006107 : $ 30 , 000 .00
Total Proposed Program Budget for 2006 /07: $ 2329829 . 03
Percent of Total Program Budget: 12 . 9 %
Current Funding ( 2004 /05 ) : $ 27 ,080
Dollar increase/(decrease ) in request : $ 2 ,920
Percent increase/ decrease ) in request 10 . 8 %
Unduplicated umber of Children to be served Individually : 361
Unduplicated Number of Adults to be served Individually : 204
Unduplicated Number to be served via Group settings : 150
Total Program Cost per Client : 325 .64
**If request increased 5 % or more, briefly explain why: We are requesting, the same level of funding
that The CSAC recommended last year prior to the budget cuts. (This is the allocation we received in
grant year 2004-2005 .)
If these funds are being used to match another source, name the source and the $ amount: N/A
The Organization 's Board of Directors has approved this application on (date). February 27. 2006
Jay McNamara
Name of PresidenUChair of the Board tgna
Ronnie Hewett
Name of Executive Director/CEO Signature
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Boys R. Gids Club of Indian Riva County, Inc. — South Canty Branch
Grant Application to the Children's services Advisory Committee
ORGANIZATION: Boys & Girls Clubs of Indian River County, Inc.
PROGRAM: South County Branch
TABLE OF CONTENTS for 2006-2007
X Section of the Proposal Pa e #
X COVER PAGE (with signatures)... .. . ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
X TABLE OF CONTENTS (check list) . . . . . . . . . . . .. . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
A. ORGANIZATION CAPABILITY (one page maximum)
X 1 . Mission and Vision of organization. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
X 2. Summary of expertise, accomplishments, and population served. . . . . . . . . . . . . . . . 4
B. PROGRAM NEED STATEMENT (one page maximum)
X 1 . Program Need Statement. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . 5
X 2. Programs that address need and gaps in service. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 5
C. PROGRAM DESCRIPTION (two pages maximum)
X1 . Funding priority. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6
X 2. Description of program activities. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
_75F 3 . Evidence that program strategy will work. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
X4. Staffing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . .
. . . . 7
X 5 . Awareness of program. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
X 6. Accessibility of program. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
X D. MEASURABLE OUTCOMES (two pages maximum) . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
X E. COLLABORATION (one page maximum) . . . . . . . . . . . . . . . .. . .... . . . . . . . . . . . . . . . . . . . 10
F. PROGRAM EVALUATION (two pages maximum)
X1 . Demographics. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
11
X2. Measures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
X3 . Reporting. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . 12
X G. TIMETABLE (one page maximum) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
H. UNDUPLICATED CLIENT COUNT
X 1 . Projections by Location . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
X 2. Projections by Age Group . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
I. BUDGET FORMS
X 1 . Financial Budget Forms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
15
2
P
Boys & Girls Club of Indian River County, Inc. — South County Branch
Gnmt Application to the Children's Services Advisory Commiaft
J, FUNDER SPECIFIC/ADDITIONAL SHEETS (On White Paper)
X 1 . List of current officers and directors. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . a . . . . . . . . . . . . . . . . . . . J- 1
2. Latest Financial Audit Report & Management Letter that conforms with the J-2
X AICPA Audit Guide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
X 3 . Most recent IRS Form 990, Including all schedules . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . J- 14
4. Most recent Internal Financial Statement (i.e. : Balance Sheet and Operating
XBudget) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . J-39
X 5 . Staff Organizational Chart. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . a . . . . . . . . . . . . . . . . . . . . . . . . .a J-44
X 6. Most recent Annual Report.. . ... . ..... . . .. .. . . ..... . .. .. . . . . . . . . . . . .. . . .. . .... . . .. .. . . . .. . ... . ... . . .. . . . .. . . J-45
X 7. 501 (C)(3) IRS Exemption Letter. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . J-79
X 8 . Articles of Incorporation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . J-80
X 9. Agency' s Bylaws. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I . . . . . . . . . . . . . . . . . .
J-94
X 10. Agency' s written policy regarding Affirmative Action . . . . . . . . . . . . . . . . . . . . . . . . . . . .. J- 104
X 11 . Parent & Member Surveys for all programs. ... . . .. . . . . . . . . . . . . . . .... . . . . . . . . . . . . . . . . . . . . . . J- 105
X 12. Taxonomy Definitions. . . .. ... . . . .. . . ... . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . J- 119
K. APPENDIX: Supporting Documentation
X 1 . Not for profit agency certification. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I
X 2. Indian River County Authorization for Release of Information. . . . . . . . . . . . . . . . . . . . II
X3 . Sworn Statement. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . V
X 4. Proof of Liability & Worker's Compensation Insurance. . . . . . . . . . . . . . . . . . . . . . . . . . . XV
3
Boys &. Gins Club of Indian Riva County; Inc. — South County ananch
Chant Application to the CbildreWs Services Advisory Cortunitt e
PROPOSAL NARRATIVE
Aa ORGANIZATION CAPABILITY (Entire Section A not to exceed one page)
1. Provide the mission statement and vision of your organization.
Mission Statement: To enable all young people, especially those who need us most, to reach
their full potential as productive, caring, responsible citizens.
Vision: To accomplish our mission by establishing neighborhood clubs and outreach services in
Indian River County with quality programs and staff.
2. Provide a brief summary of your organization including areas of expertise,
accomplishments, and population served.
The Boys & Girls Club of Indian River County offers a diverse, affordable program to kids in a
positive atmosphere. Our daily after-school and summer programs, offered through our
"Clubhouse" locations and our outreach services that are provided through our Youth Volunteer
Corps, allow us to provide valuable services to the children of Indian River County. These
program activities attract and sustain young people, ages 6 through 18, who pay a nominal
annual membership fee of $35 .00 (which includes a free Boys & Girls Club t-shirt) and a
summer program fee which vanes by location. In cases of financial hardship, no kid is turned
away because we have established a scholarship fund. Youth Volunteer Corps members do not
pay any fees.
Nowhere in the Indian River County area can kids or parents find such valuable services offered
in multiple locations so inexpensively. While our method of program delivery may change with
seasonal activities, or school related endeavors, the core of what and how we conduct daily
activities remains much the same. The overall Boys & Girls Club program structure can be
divided into "Five Core Service Areas". Together, these core service areas provide a diverse
base of activities designed to meet the needs and interests of every member. The following Five
Core program areas represent the Club's service offerings to its membership:
• Education and Career Development. . . enables youth to become proficient in basic
educational disciplines, apply learning to everyday situations and embrace technology to
achieve success in a career and life in general.
• Character and Leadership Development. . . empowers youth to support and influence their
Club and community, sustain meaningful relationships with others, develop a positive self-
image, participate in the democratic process and respect their own and others' cultural
identities.
• Health and Life Skills . . . develops young people's capacity to engage in positive behaviors
that nurture their own well-being, set personal goals and live successfully as self-sufficient
adults.
• The Arts . . .enables youth to develop their creativity and cultural awareness through
knowledge and appreciation of the visual arts, crafts, performing arts and creative writing.
W • Snorts, Fitness and Recreation. . . develops fitness, positive use of leisure time, skills for stress
management appreciation for the environment and social skills.
4
Boys & Girls Club of Indian River County, Inc. — South County Branch
Grant Application to the Children's Services Advisory Committee
B. PROGRAM NEED STATEMENT (Entire Section B not to exceed one page)
1. a) What is the unacceptable condition requiring change? b) Who has the need?
c) Where do they live? d) Provide local, state, or national trend data, with reference
source, that corroborates that this is an area of need.
a Limited access to affordable after school and summer programs for children 6 — 18 years of age, low
economics,juvenile crime and below aveaW academic achievement is the condition requiring change.
b. We define those in need as children between the ages of 6 years old that have completed kindergarten
through 18 years of age, with a special interest in working with disadvantaged youth. We define
disadvantaged youth as children ftom low economic status, one-parlent families and latch key kids.
c. Through our South County Branch, located at 683 27 h Avenue SW, we mainly serve children who
live within close proximity or who attend Thompson Elementary, Highlands Elementary, Oslo Middle
and Veno Beach High School
d. Aoomding to the Florida Department of Education of the 16,619 children who attend Indian River
County public schools, 6,618 or over 39% receive free or reduced lunches (which is an indicator of
economic hardship). Additionally Dodgertown, Highlands, and 'Ihompson Elementary, Oslo Middle
School and Vero Beach High School are rated as `B" Schools according to the School District of Indian
River County. Finally, Indian River County statistics from the FL Department of Juvenile Justice
Bureau of Data and research conclude that 61/6 of all 10- 17 year olds have been
referedtothe juvenile justice system during 2003-2004.
2. a) Identify similar programs that are currently serving the needs of your targeted
population; b) Explain how these existing programs are under-serving the targeted
population of your program.
a. The Boys & Girls Clubs of Indian River County is the only county-wide, facility based,
youth development organization that provides programming every day after school and all
day during the summa. For every child the Boys & Girls Clubs serves, our youth
development activities are designed to build the following traits:
• Positive self-identity. A healthy self-concept, a strong belief in one' s self-worth, and a
sense of hope about one's future.
• Educational, employment, social, emotional and cultural competencies. The knowledge,
skills, strategies and attitudes necessary to have a positive foundation for success.
• Community and civic involvement. A sense of belonging to community, family and/or
group; willingness to take civic responsibility.
• Health and well-being. Living a healthy lifestyle, taking part in regular fitness activities,
able to access health care resources and engage in positive behaviors.
• Moral compass. Youth have values enabling them to develop positive relationships with
others.
b. Our target population is underserved by other programs for the following reasons:
affordability, accessibility and scope of services.
\r/
5
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Boys & Girls Club of Indian River County, Inc. — South County Branch
Grant Application to the Children's Services Advisory Committee
D. MEASURABLE OUTCOMES - PROPOSED. (Section D not to exceed two pages)
OUTCOMES ACTIVITIES
List all of the el,MMfor the Measurable Outcomes List the tasks to awom lish the Outcome(s)
1 . To maintain the average daily attendance of • Distribute Membership Recruitment Flyers in
South Comity Branch Club members 100x/• the schools to announce after school program in
(75) as reported by the 2006-2007 year end the beginning of the school year and summer
average daily attendance totals. Baseline: 2005- programs at end of the school year.
2006 average daily attendance totals. . Offer an annual membership fee of$35 .00.
• Provide transportation atter school through
Indian River County School District to the Boys
& Girls Club.
2. To maintain juvenile crime rates of enrolled • provide daily diversion activities at the Club to
10 - 17 year old Club Members to less than channel youth energies into a positive direction.
2% compared to non-club members which is Games room tournaments and outdoor
6% as reported by the 2003-2004 juvenile playground activities will be offered initially to
arrests. Baseline: 2003-2004 Indian River spark member' interest. Once a rapport is built
County statistics from the FL Department of with our members, staff will encourage
Juvenile Justice Bureau Data. (6% of all 10- participation within our five core program
17 year olds referred to the juvenile justice service area.
system) • Nominate eligible, deserving 14 year olds as
Youth of the Month Nominees will be
requested to complete a nomination form to be
judged to determine the organizations Youth of
the Year.
• ContimmT Wiance a Keystone Club for
members 14 — 18 years that will meet a
minimum of once a month
• Continue/Enhance a Torch Club for 11 -13 year
olds that will meet a minimum of once a month
• Create a Passport to Manhood program for 11
year old boys & up that will meet once a week
for 8 weeks.
• ContinueTInhance the SMART Moves program
for all age groups that will be offered on a
weekly basis.
• Continue/Enhance a SMART Girls program
that will be offered weekly, for girls ages 10-15.
The program is designed to encourage healthy
attitudes that will enable early adolescent girls to
develop to their full potential.
• Implement a violence prevention program that
meets once aweek for 12 weeks in collaboration
with Safe Space. (Pending availability of Safe
Space staff
8
• Boys It Gins Club of Indian River County, Inc. — South County Branch
Great Application to the Children's Services Advisory Committee
• briplement an anger management and conflict
resolution program that meets once a week for 8
weeks in collaboration with Safe Space.
availability of Safe Space
3 . ImprovetMaintain grade and skill levels of • Provide daily Homework Help, Reading &
no less than 65% of Club members Math skills enhancement activities, One-On-
participating in its Power Hour programs by One and Group Tutoring, POWER Pages and
grants end September 30, 2007. Baseline: POWER Point activities during the school year.
I " quarter school grades compared to 4`" • Maintain good grades pies quarterly to
quarter grades. celebrate improv its in school performance.
• Meet with school officials to identify those
members who are failing and provide additional
homework and tutoring support
• ContinuelEnhance a peer leader homework and
tutoring program 5 days a week during the
school year.
• Maintain a Goals for Graduation program that
meets one a week for 12 weeks.
• Maintain a Goals for Growth program that
meets once a week for 8 weeks.
• Maintain a Job Ready program that will be
offered during the summer.
1 • Maintain a Career Launch program that will be
V offered year round to teenagers accessing the
web at the Boys & Girls Club.
• Provide daily access to computers to improve
technology competency levels.
4 . Maintain 1006/o parent involvement of Club • Maintain a Family Support program, which is
members in our South County Branch (204) designed to provide seasonal activities, events
as reported by the 2006-2007 Parent and services designed to strengthen family
attendance at Club events. Baseline: 2005- relations through informal social support.
2006 Parents attendance at Club. • Maintain a Family Advisory Network (FAN
Club) that will meet 4 times a year.
• Distribute Parent Surveys once a year to
evaluate quality ofprogram and determine other
service areas to offer.
9
Boys & Girls Club of Indim Riva County, Inc. — South County Branch
Grant Application to the Childmn°s Services Advisory Committee
E. COLLABORATION (Entire Section E not to exceed one page)
1. List your program's collaborative partners and the resources that they are providing to
the program beyond referrals and support.
Collaborative Agency Resources provided to the program
Indian River County School District Transportation after school from area schools to the
Boys & Girls Club. After school snacks and summer
lunch program.
Homeless Family Center Offer scholarships to children of homeless families, provide
computer lab access to children (through programs offered to
Club members) and parents/guardians (in the evenings to
teach computer skills and help with resumes and job
placement services).
Center for the Arts Art instruction, supplies, place to host exhibits and
museum in the basket series.
Youth Guidance Coordinate mentoring opportunities and encourage
Youth Guidance participants to become members of the
Boys & Girls Club and promote Mentor and Mentees to
meet at the Boys & Girls Club.
Homeless Family Assistance Center We offer scholarships to child residents to participate in
our programs and computer lab time/help to parents.
Samaritan Center We offer scholarships to child residents to participate in
our programs.
Safe Space Provide instructors to conduct conflict resolution,
domestic violence and anger management sessions.
Boy Scouts Volunteers to conduct troops at the B&G Club once a
week.
Girl Scouts Volunteers to conduct troops at the B&G Club once a
week.
10
Boys & Girls Club of Indian River County, Inc. — South County Branch
Grant Application to the Children's Services Advisory Committee
F, PROGRAM EVALUATION (Entire Section F not to exceed two pages)
L DEMOGRAPHICS: What information (data elements) will you need to collect in order
to accurately describe your target population including demographics (age, gender, and
ethnic background) required by the funder in Section H? What are the pieces of
information that qualify them for your target population? How do you document their
need for services or their "unacceptable condition requiring change" from Section Bl ?
Each participant will be required to fill out a membership application that is manually entered
into a computer software program called "Member Tracking". This program allows us to
electronically maintain a database on each member that includes demographic, age, gender, race,
family economics, daily attendance, and activities in which they participated.
Our target population is tracked by age. We are able to track our special interest in serving
disadvantaged youth by asking and collecting the following:
• Does your child receive free or reduced lunch? (Asked to determine low economics).
• Who does your child live with? (Asked to determine single parent family status).
• We collect report grades on a quarterly basis.
• We submit our membership list to the Department of Juvenile Justice to determine any
Juvenile arrests of members.
Limited access to affordable after school programs for children 6 — 18 years of age, low
economics, juvenile crime and below average academic achievement is the condition requiring
change.
2. MEASURES: What data elements will you need to collect to show that you have
achieved (or made progress toward) your Measurable Outcomes in Section D? What
tools or items are you using as measures (grades, survey scores, attendance, absences,
skill levels) for your program? Are you getting baseline information from a source on
your Collaboration List in Section E? Are there results from your Activities in Section
D that need to be documented? How often do you need to collect or follow-up on this
data?
• Membership Applications are collected upon registering for the program. Membership
renewal applications are updated continuously throughout the year, with the bulk
registering at the beginning of the school year.
• Daily average attendance is collected by recording the number of members that attend
daily divided by the numbers of days of service. Results are maintained and available on
a monthly basis.
• Club Activities are collected daily to track members' participation in the various
activities that are offered throughout the day.
• Pre and Post Surveys are distributed prior to all drug, alcohol and teen pregnancy
prevention programs to measure the knowledge gained through participation in our
SMART Moves programs.
• Juvenile Crime Rates will be collected by providing the Department of Juvenile Justice
with the names of all children enrolled in the program; they will then notify us regarding
the number of members arrested. Comparisons can be run on a quarterly basis.
• School Achievement will be measured by collecting report card data and providing a
11
Boys & Girls Club of Indian River Claunty, Inc. — South County Branch
Arlt Application to the Chlltest'a Services Advisory Committer
comparison of grades from quarter to quarter. A baseline will be established the 1
quarter of each year and compared to results at the end of the year.
• Parent & Member Surveys will be distributed to each parent & member in April to
evaluate services being delivered.
• B&GCA Outcome Measurements Tool every member is encouraged to enter a baseline
survey upon registering for the program. Ongoing surveys are administered each year.
1 . 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?
Public trust and accountability are our top priority. Our core promise to our members is to
provide a safe positive place and have a positive impact on their lives. We accomplish this by
upholding high ethical standards in all areas, especially in overseeing our finances, providing
accurate membership data, being good stewards of the donor dollar and representing ourselves to
the public.
We plan on presenting an organizational annual report in 2007, which will showcase the
outcome of our core promise to our members, funders and the community.
Finally, all of the information we gather as a result of our measures will enable us to
continuously update and improve our program to ensure it meets the needs of our members and
the community.
12
Boys & Girls Club of Indian River County, Inc. — South County Branch
Grant Application to the Childrm's Services Advisory Committee
G. TIMETABLE (Section G not to exceed one page)
1 . List the major action steps, activities or cycles of events that will occur within the program
year. New programs should include any start-up planning that may occur outside the
funding year. In completing the timetable, review information detailed in prior sections.
Month/Period Activities
January 2006 Develop Program Budget for February Approval
March 2006 Write and Prepare United Way Grant
May 2006 Develop Summer Program Schedule that incorporates
all the National Programs mentioned in section C3 .
May 2006 Write, Prepare and Submit Children's Services
Advisory Committee Grant
May 17 — 22; 2006 Summer staff training & Building Maintenance
May 23, 2006 1 Day of Summer Program offers hours Monday —
Friday 8 a.m. — 6 p.m.
August 2006 Distribute Parent & Members Surveys
August 2006 Develop School Year 2005-2006 Program Schedule
that incorporates all the National Programs
mentioned in section C3 .
August 21 25, 2006 School Year Staff training and Building Maintenance
November, February, May, August. Evaluate Boys & Girls Club Program utilizing
Commitment to Quality 4 times a year.
13
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UNIFORM GRANT APPLICATION
TOTAL PROGRA BUDGET
_ AGENCYIPROGRAM NAME: Boys & Girls CIut s o1 Ind lan River Cou /South County Branch
PY 0/45 FY 061011 FY 08107 % INCREASE
FYE Jue4 30 In Jum 30 FYE Juin 30 CURRENT VS.
NEXT FY BUDGET
A 9 C D
ACTUAL TOTAL PROPOSED lex sex 9)e . 5
REVENUES BUDGETED BUDGETED
ChBdten'sCoundIM Lucia 0.00 0.00 .0.00 NDIVNI
CMMren'sSeIvicas.. COUncil-Martin 0.00 0.00 0.00 #DIVIOI
CoauaNtee-Indian River 35 708.29 25.800.00 30 000.00 4.17%
Usited Lucia Cwntv 0.00 0.00 0.00 #DIVIOI
United W -Moran Cou 0.00 0.00 0.00 #DIVI01
United 4ndke River Countv 39 989.96 40 000.00 45 000.00 12.50%
of Child" & Families 0.00 0.00 moo #DIV101
FwWs 0.00 0.00 0.00 #DIVIOI
-Cash 9 325.25 2500.00 2 500.00 - 0.00'/.
1 P Fees 3370.25 797000 1875000 135.26%
11 Fund RaWm Events-Net 727.45 3.750.00 0.00 -100.00%
12 Sake to Publictlet 0.00 0.00 0.00 #DIVIOI
13 Membershio Dues S .00 72760.00 81750.00 12.90'.
14 Investment Income 0.00 0.00 0.00 arolVrol
1s aneneom 0.00 0.00 0.00 #DIVIOI
Is ke8 soqpnft 0.00 0.00 0.00 #DIVmI
17 Funds from Other Sources 27 968.07 53 671.00 50 889.00 60.71%
is Reserve Funds Used for O;;zng 0.00 0.00 0.00 #DIVIOI
t9lin4lind Oonatlom pm xKwe.a % bow 43804.25 0.00 0.00 #DIVIOI
TOTAL 123 492.27 144.441.00 185 889.00 28.70%
EXPENDITURES
21 Sateda8 111700.84 123 896.50 129 T5 4.79%
22 FICA 863225 10 70.00 9A32.28 .5.21%
23 Relimment 959.05 41,530.00 . 3154.00 30.38%
L8a81esBh 537.09 81m.00 8376.00 1.81%
orkais n
1.639.50 2.573.00, 2 502.00 -2.76%
28 Florida Unemplovinard 266.03 378.00 1.323.001 250.00%
27 Trivel-Dally 193.73 500.00 500.00 0.00%
28 Tm Wgm'vrerces/Tratnin 1650.12 21750.00 3500.00 27.27%
29 Olflce SUP01195 857.51 750.00 750.00 0.00%
30 T010hone 3042.44 3,340.00 Z340,00 -29.94%
31 Posimse/Shipaina 208.21 200.00 200.00 0.00%
32 Utilities 4188.00 5 200.00 560000 5.77%
33 Oceupancy (Buildina & Grounds - 27 682.15 31 800.00 32j250.00 1.42%
34 Printine i Publications 2 630.77 1600.00 1600 00 0.00%
36 tlerahi 146.20 2345.00 2625.00 11.94%
34 Irnura 4,997,80 8,439.00 9,793.00 16.04%
37 E i nERamal 5 Maintenance 3,010.37 Z647 00 2,742.00 3.7956
sa =Ina 0.00 0.00 0.00 #DfVrol
39 Eaukorient Purchasas:Ca ital ExPenss 0.0o 0.00 0.00 #DIV/01
40 Profess Foes (Legal, Coneu n 0.00 0.00 0.00 #DIV/OI
41 BoolmlEducational Materials 4.347.41 Z991.00 3750.00 25.7%'
42 Faod 8 NUITHIM 1742.46 1 600.00 11800.00 0.00%
43 Administrative Costs 238.58 325.00 260.00 -23.08%
44 Audit Expense 1,875 2,000.00 6.67%
46 Mc Assistance to individuate 0.00 0.00 0.00 #DIVI01
46 omedMiscellaneoua 840252 709600 830800 17.10%
7 Odw/Contract 269547 0.00 0.00 #DIVIOI
TOTAL 204850.85 223 50 232829.03 4.164A
491REVENUES OVER/(UNDER EXPENDITURES -81,206.581 779093.50 46940.03 -40.65%
S'L9'Cm p
Boys & Gk* C*M sfbdWn ftwCm*. Bic
Bosh om** grsm
UNIFORM GRANT AIPPUCATION
FUNDER SPECIFIC BUDGET
PROGRAM EKPENSES
AGENCY/PROGRAM NAME: Boys & Girls Clubs of Indian River County/South County Branch
FUNDER: Children's Services Advisory Cor A B C
FY 06107 ;BUDGET
06107 % OF
TOTAL DER TOTAL VS.
PROGRAM CIFIC FUNDER REQUEST
BUDGET col. Weal. A
EXPENDITURES
27 Salaries 129x833.751 25 000.00 19.26%
22 FICA 9,932.28 1 ,912.60 19.26% '
23 Retirement 3154.00 0.00 0.00%
24 Life/Health 81376.00 31087.50 36.86%
25 Workers Compensation 2502.00 0.002 0.00%
26 Florida Unemployment 19323.00 0.00 0.00%
27 Travel-Daily 500.00 0.00 0.00%
26 Travel/Conferencesff raining31500.00 0.00 0.00%
29 Office Su lies 750.00 0.00 0.00%
30 Telephone 29340.00 0.00 0.00%
rr' 31 Postage/Shipping 200.00 0.00 0.00%
32 Utilities 550000 0.00 0.00%
33 Occupancy (Building & Grounds 3225000 0.00 0.00%
34 Printing & Publications 11600.00 0.00 0.00%
35 SubscriptionIDues/Memberships 262500 0.00 0.00%
36 Insurance 99793.00 0.00 0.00%
37 E ui ment:Rental & Maintenance 2 742.00 0.00 0.00%
38 Advertising 0.00 0.00 #DIV/01
39 Equipment Purchases :Ca ital Expense 0.00 0.00 #DIV/01
46 Professional Fees (Legal, Consultinal 0.00 0.00 #DIV/01
41 Books/Educational Materials 39750.00 0.00 0.00%
42 Food & Nutrition 160000 0.001 0.00%
43 Administrative Costs 250.00 0.00 0.00%
44 Audit Expense 200000 0.00 0.00%
45 Specific Assistance to Individuals 0.00 0.00 #DIV/01
46 Other/Miscellaneous 89308.00 0.00 0.00%
47 Other/Contract 0.00 0.00 #DIV/01
232 829.03
,e48 TOTAL $232,829.03 $30000.00 12.88%
5232008 21
e - c
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aa. arasowsanw�anwcaury. uc
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UNIFORM GRANT APPLICATION
EXPLANATION FOR VARIANCES OF 15% OR MORE
FUNDER SPECIFIC BUDGET
&NCYIPROGRAM NAME: Boys & Girls Clubs of Indian River County/South County Branch
FUNDER: Children's Services Advisory Conwri tree
is for the 1' mov W of our s uWqrooneft for which the portion of this One item charged off to this gram
S would be 19.26% of the One Ram's
Our requester for are funding part Minch&inch Directofs saleryNenefils for which the portion of this line Rem charged off to this gram
would be 19.26% of the One item's budgeL
Our request is for the funding pad of our Branch Director's salaryAmmilts for which the portion of this One item Merged off to this gram
Life/HealthLife/Health would be 36.86% of the One Rem's
mmilif
alt
I
aD I
snsasoe 23
Boys & Girls Club of Indian River County, Inc. - Sebastian Branch
Grant Application to the Children's Services Advisory Committee
PROGRAM COVER PAGE for 2006-2007
Organization Name : Boys & Girls Clubs of Indian River County, Inc.
President & CEO : Ronnie Hewett E-mail : RonnieHewett@BGCIRC.org_
Address: P.O. Box 643068 Telephone: 772-299-7449
Vero Beach, Florida 32964-3068 Fax: 772-299-3840
Director of Finance : Heidi Watkins E-mail : HeidiWatkins@BGCIRC .org
Address: P.O. Box 643068 Telephone : 772-299-7449
Vero Beach, Florida 32964-3068 Fax: 772-299-3840
Program Title : Sebastian Branch
Priority Need Area Addressed: Mental Wellness Issues and Childcare Access
Brief Description of the Program: Taxonomy Definition PS-980. 100: Programs that provide a wide
range of supervised recreational activities and delinquency prevention services for children and youth
of all ages and backgrounds, but particularly for disadvantaged youth, through membership in boys
and/or girls clubs. Club members are entitled to use recreational facilities and may have access to
counseling, tutorial services, employment assistance, gang programs, drug abuse and alcoholism
prevention and other activities and services that direct their energies toward positive social goals and
facilitate healthy personality development.
SUMMARY REPORT — (Enter Information In The Black Cells Only)
Sebastian
Amount Requested from Funder for 2006 /07 : $ 35 ,000 . 00
Total Proposed Program Budget for 2006 /07 : $ 315 , 749 . 33
Percent of Total Program Budget : 11 . 1 %
Current Funding ( 2004 /05 ) : $ 31 , 593
Dollar increase/( decrease ) in request : $ 3 , 407
Percent increase/ ( decrease ) in request * * : 10 . 8 %
Unduplicated Number of Children to be served Individually : 625
Unduplicated Number of Adults to be served Individually : 225
Unduplicated Number to be served via Group settings : 110
Total Program Cost per Client : 328 . 91
* *If request increased 5 % or more, briefly explain why: We are requesting the same level of funding
that the CSAC recommended last year prior to the budget cuts. (Since we opened our new Sebastian
Club in January operating costs have gone up significantly and continue to rise as we approach a full
budget year of operation.)
If these funds are being used to match another source, name the source and the $ amount: N/A
The Organization 's Board of Directors has approved this applicatio} n (date). 27. 2006
Jay McNamara
Name of President/Chair of the Board tg tt
Ronnie Hewett \
Name of Executive Director/CEO Signature
1
EXHIBIT B
(From policy adopted by Indian River County Board of county Commissioners on February 19,
2002)
"D. Nonprofit Agency Responsibilities After Award 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 151 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 and (September 301h) must be submitted on a timely
basis . Each year, the Office of Management and 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 expense by type. These summaries
should be broken down into salaries , benefit, 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."
EXHIBIT - B -
EXHIBIT C
STANDARD TERMS FOR GRANT CONTRACT
1 . Notices. Any notice, request, demand , consent, approval, or other communication
required or permitted by this Contract shall be given, or made in writing, by any of the
following methods : facsimile transmission ; hand delivery to the other party; delivery by
commercial overnight courier service; or mailed by registered or certified mail (postage
prepaid), return receipt requested at the addresses of the parties shown below:
County: Brad E. Bernauer, Director
Indian River County Human Services
1840 251h Street
Vero Beach , Florida 32960-3365
Recipient : Boys & Girls Clubs of Indian River County, Inc.
P.O. Box 643068
Vero Beach , Florida 32964
2 . Venue; Choice of Law. The validity, interpretation , construction, and effect of this
Contract shall be in accordance with and governed by the laws of the State of Florida
only. The location for settlement of any and all claims , controversies , or disputes, arising
out of or relating to any part of this Contract, or any breach hereof, as well as any
litigation between the parties , shall be Indian River county, Florida for claims brought in
state court, and the Southern District of Florida for those claims justifiable in federal court.
3. Entirety of Agreement. This Contract incorporates and includes all prior and
contemporaneous negotiations, correspondence, conversations , agreements, and
understandings applicable to the matters contained herein and the parties agree that
there are no commitments, agreements, or understandings concerning the subject matter
of this Contract that are not contained herein . Accordingly, it is agreed that no deviation
from the terms hereof shall be predicated upon any prior representations or agreements ,
whether oral or written . It is further agreed that no modification , amendment or alteration
in the terms and conditions contained herein shall be effective unless contained in a
written document signed by both parties.
4. Severability. In the event any provision of this Contract is determined to be
unenforceable or invalid, such unenforceability or invalidity shall not affect the remaining
provisions of this Contract, and every other provision and term 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 context indicates otherwise, words importing the singular number
include the plural number, and vise 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.
EXHIBIT - C -
aeet ivienjr ¢ uuo T101as 4e2 '/ YM TO : ® 299 - 3640 Page : 005
ACORD10/223/20063/2006
TM CERTIFICATE OF LIABILITY INSURANCE OAT/
PRODUCER ( 772 ) 231 - 2828 FAX ( 772) 231- 4413 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Felten & Associates ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
2911 Cardinal Drive (32963 ) HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
P . O . Box 3488 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Vero Beach , FL 32964- 3488 INSURERS AFFOgRetail
AGE NAICH
INSURED Boys & Girls Club of Indian River County , Inc . INSURERA. Philademnity Ins Co
P . O . Box 3068 INSURERS FloriFederation
Vero Beach , FL 32964- 3068 INSURER C:
INSURER D'
INSURER E
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSRLTR DD'L TYPE OF INSURANCE POLICYNUMBER POLICYEFFECTIVE POLICY EXPIRATION DATE fMMn)Dh)l LIMITS
GENERAL LIABILITY PHPK190417 09/13 /2006 09/13 /2007 EACH OCCURNE
1 , 000 , 000
X COMMERCIAL GENERAL LIABILITY DAMAGE TO 100 , 000
CLAIMS MADE 1K OCCUR MED EXP (An5 , OD
A PERSCNAL & 1 , DOD , OOGENERAL AG3 r 000 , 00GEN'L AGGREGATE LIMIT APPLIES PER'. PRODUCTS - 3
, 000 , OO
POLICY PEo- F7 LOC
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT
ANVAUTO (Ea accldentl $
ALL OWNED AUTOS
SCHEDULED AUTOS Beer person) $
ODIL INJURY
HIRED AUTOS
NON-OWNED AUTOS (Per
den)) $
BO ILY INJURY
PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY jA�ONLYin
ANYAUTO ESSNMBRELLA LIABILITY OCCUR O CLAIMS MADE DEDUCTIBLERETENTION $
WORKERS COMPENSATION AND 520- 25864 09/13/2006 09/13 /20072
6
STATU- X OM
EMPLOYERSLIABILITY LIMITS
B ANY PROPRIETORIPARTNERIEXECUTIVE E.L. EACHACCIDENT $ 500 , 000
OFFICER/MEMDER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $ 500100
It yes, cestode under
SPECIAL PROVISIONS bebry E . DISEASE - POLICY LIMIT $ SOO , OOO
rotessional Liability PHPK190417 09/13 /2006 09/13 /2007 $ 1 , 000 , 000 Occurrence
A
$ 3 , 000 , 000 Aggregate
DESCRIPTIONOF OPERATIONS I LOCATIONS I VEHICLES 1 EXCLUSIDNS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
ertificate holder is named additional insured
FIRTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
Indian River County Board 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
of County Commissioners BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
1840 25th St OF ANY KIND UPON THE INSURER ITS AGENTS OR REPRESENTATIVES.
Vero Beach , FL 32960 AUTHORIZED REPRESENTATIVE
Kenneth D . Felten LUTCF ]AFw.
ACORD 25 (2001108) OOACORD CORPORATION 1988
y : zi ria TO ; l4 LYY - lU40
Page : 006
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may
require an endorsement. A statement on this certificate does not confer rights to the certificate
holder in lieu of such endorsement(s).
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between
the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it
affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon .
ACORD 25 (2001108)
owe , i � i � � ic � vo mlmat • : ei rn •ro : z9Y - Stl4V Page ; 007
r
Additional Coverages and Factors 10/23/2006
Line of Business Coverages for General Liability
Coverage Limits Ded/Ded Type Rate Premium Factor
General Aggregate 390009000
Products /Completed Ops 3 , 0001000
Aggregate
Personal & Advertising 130009000
Injury
Each Occurrence 190009000
Fire Damage 100 , 000
Medical Expense 59000
Abuse/Molestation /Occur 1 , 0002000
Abuse/Molestation/Aggr 190005000
Employee Benefits 1 , 000 , 000