HomeMy WebLinkAbout2006-331M. f-�
INDIAN RIVER COUNTY
GRANT CONTRACT
This Grant Contract ("Contract") entered into effective this -j2l�01 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 H .O . P . E . Academy. (Recipient), of:
H .O .P. E. Academy
4875 43rd Avenue
Vero Beach , Florida 32967
H .O . P . E. Academy Program
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: NINETY
THOUSAND, DOLLARS ($90, 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 Obligation 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.
IN WITNESS WHEREOF , County and Recipient have entered into this Contract on the date
first above written .
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INDIAN RIVER (
NTY BOAMOF COMMISSIONERS
\ n • • J
By:
Arthur! r�Nguber , airman
BCC Approved :''
Attest: J . K. Barton , Clerk )d
By: j�
Deputy Clerk
P
Approved :
Jose9h A. Baird
County Administrator
Approved as to form and legal sufficiency:
B ,
Martian E. Fell , Asftlant County Attorney
REC40 . P .
By:
Academy
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EXHIBIT A
(Copy of complete Request for Proposal )
EXHIBIT - A -
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 15` 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 -
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PROGRAM COVER PAGE
Organization Name: Error! Not a valid link.
Executive Director: Shekina Michelle E-mail :
Hope_cad@bellsouth.net
Address : 4875 43RD Ave. Telephone : 772-562-4325
Vero Beach Fl, 32967
Fax : 772-562-6965
Program Director: Shekina Michelle E-mail :
Hope_cad@bellsouth.net
Address : 487543 rd Avenue Telephone: 772-562-4325
Vero Beach Fl. 32967
Fax : 772)562-6965
Program Title: Error! Not a valid link.
Priority Need Area Addressed:_ Education with Parental Suoport
Brief
Description of the Program: CSC Taxonomy Code HD-050-------- HOPE ACADEMY focuses on
treating special problems for children ages 7 — 18 We also have a family component a monthly 2 hr
workshop for their parents on Parental Empowerment and enrolling consoling
SUMMARY REPORT — (Enter Information In The Black Cells Only)
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Amount Requested from Funder for 2006 / 07 : $ 955550 . 60
Total Proposed Program Budget for 2006 / 07 : $ 191 , 175 . 39
Percent of Total Program Budget : 50 . 0 %
Current Program Funding ( 2005 /06 ) : $ 909265
Dollar increase/( decrease ) in request : $ 51286
Percent increase /( decrease ) in request * * 5 . 9 %
Unduplicated Number of Children to be served Individually : 485
Unduptfutrtir"— tmber of Adults to be served Individually : 24
Unduplicated Number to be served via Group settings : 155
Total Program Cost per Client : 287 . 91
* * If request increased 5 % or more, briefly explain why: Most of our increase is due to the cost of
living. As you can see, it is barely over 5 %. In all actuality we need more. (like $ 100 00)
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). _5/22/06
_HENRY BURSON
Name of President/ of the Boo Signa
orvl
Name of Executive Director/CEO nature
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PROPOSAL NARRATIVE
Please respond to each question in the allotted space for each section. In responding to each section of
the proposal narrative, please retain the section-label and/or question that you are addressing. Type
using 12 pt. font on 8 %" X 11 " paper and number each page. These directions and the graphic boxes
may be deleted if space is needed.
A. ORGANIZATION CAPABILITY (Entire Section A not to exceed one page)
1 . Provide the mission statement and vision of your organization.
H.O.P.E. Academy seeks to revive moral and social values. Also, to help build self esteem
and empower the community with skills that will help them achieve, succeed, and excel;
focusing primarily on suspended students. The acronym H.O. P.E. stands for Helping
Other People Excel and our motto is expressed through our slogan, "Instilling the Desire to
Aspire."
2. Provide a brief summary of your organization including areas of expertise,
accomplishments, and population served.
As an alternative program to out-of-school suspension, H.O.P.E. Academy provides these
at-risk youth a safe, peaceful and structured setting while suspended from school. They
receive one on one tutoring with their regular class assignments, taught behavior
modification techniques and management skills. We provide an opportunity for the
students to have their suspended days reduced or exonerated altogether. We have daily
group discussions designed to bolster self esteem and life skills that instills "a desire to
aspire."
We are open for any of the 1 ,600 students attending the Indian River County schools that
are subject to be suspended,
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B. PROGRAM NEEDS 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) Students that are suspended from school and are left alone without adult
supervision become at-risk. With additional unsupervised time they are subject to
engage in promiscuity, drugs, alcohol, or some other crime. Practically all of
students suspended from school return with few assignments if any at all. They also
return with no instructions on behavior modification or coping skills.
Since suspensions are unexcused absents, they must be reported to the state as
unexcused. Allocated funds are reduced when they are reported as suspended.
Also, family dynamics are a major factor in improving the behavior of children.
Most parents of suspended students need additional knowledge on coping skills and
effective parenting as well.
B) According to School District's Informational Service Department, statewide there is
An average of 10 — 12 per cent of the student body suspended annually. That
equates to over 1600 students in this district alone.
All national data has proven that juveniles with unsupervised time are more likely
to get into serious trouble.
C) As of now, any suspended student of Indian River County is eligible for our
program
D) See attachment 7.
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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) There are no programs that are serving the needs that we have targeted.
B) The only way we are under serving is the need to be in more strategist locations.
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C. PROGRAM DESCRIPTION (Entire Section C, 1 — 6, not to exceed two pages)
1 . List Priority Needs area addressed.
Error ! Not a valid link.
2. Briefly describe program activities including location of services.
The first thing a student must do is to register. After being registered and enrolled into
H.O.P.E., the student is assigned to a class by the Program Director who coordinates
enrollment. Our campus is located at Gifford Youth Activity Center.
After the student is assigned to a class, the teacher diligently assists the student in
completing assignments brought to the Academy by the parents or guardian from their
regular school. Our daily "Rap Sessions" teach our students coping skills. So, the student
hopefully returns to their regular school on pace academically and with \a modified
behavior. Within the month of each student leaving our instructors mail a motivational
letter to the students they taught reminding them of the goals they made while they were at
HOPE.
Each student's record is reviewed at the end of the year to see if they were re-suspended.
3. Briefly describe how your program addresses the stated need/problem, Describe how
your program follows a recognized "best practice" (see definition on page 12 of the
Instructions) and provide evidence that indicates proposed strategies are effective with
target population.
Last year there were over 1500 students suspended from school. The 2002 Tennessee Art
Commission defines and "at risk youth as any child or young person at risk of delinquency
or engaging in any other problem behaviors such as : Substance abuse, pregnancy, and
drop-out.
Just by having the student at our Academy, it extremely reduces the likelihood or risk of
the suspended student engaging in additional deviant behavior due to unsupervised time.
For three consecutive years in a row, our statistics from the Informational Services
substantiate the fact that suspended students that attended HOPE was less likely to be re-
suspended. (review Attachment 2)
We have each of our students write what we call an exit essay, the thing that' s mentioned the
most is had they not come to HOPE Academy they would not have completed their
assignments. (attachment 3)
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4. List staffing needed for your program, including required experience and estimated
hours per week in program for each staff member and/or volunteers (this section
should conform to the information in the Position listing on the Budget Narrative
Worksheet).
1 ) Administrative Director must be a qualified instructor with at least a college degree,
administration skills and experience; working 40hrs/weekplus. Position is salary
based.
2) Administrative/Staff Assistant must have supervisory skills, typing skills, data entry
skills, the ability to form statistical reports and work with both office staff and
students. This person will work at least 40 hrs/week.
3) Clerical/staff assistant must have office skills and some bookkeeping knowledge.
This person will assist instructors when needed and work at least 40hrs/week.
4) Two instructors ; that must be qualified with a Bachelors Degree and have special
skills to work with a Hope caring-like spirit for suspended at-risk youth. They
would have a 40hrs. work week and the position is salary based.
5. How will the target population be made aware of the program?
At the time of the student's suspension, the student and the parent are given a tri-fold
about Hope Academy. We will continue to use the media to market HOPE : such as the
press journal, school district television station school posters and radio.
At the beginning of the school year, our board members will speak at PTA, SAC meetings,
Open Houses, and School Orientations.
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We will mail information about HOPE to Middle and High school parents.
6. How will the program be accessible to target population (i.e., location, transportation,
and hours of operation)?
Parents of the students are the primary source of transportation. This gives them
additional bonding time. Since HOPE is located in the central region of the district,
transportation is provided by the school district when parents are completely unable to
transport their child.
Our hours of operation are synchronized with the regular school day which causes
minimum disruptions in the family's daily routine.
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D. MEASURABLE OUTCOMES (Description oflntent)
Use the Measurable Outcomes form. This description page does not need to be included in the ro osal.
In order to show the impact that your program is having on the target population and the
community, the funders are requiring measurable outcomes. Please review the examples and
summaries below to insure your understanding of what is expected.
OUTCOMES : Describes what you want to achieve with the target population. Indicates the
results of the services you provide, not the services you provide. Outcomes utilize action words
such as maintain, increase, decrease, reduce, improve, raise and lower.
ACTIVITIES : Describes the tasks that will be accomplished in the program to achieve the
results stated in the outcomes . Activities utilize action words such as complete, establish, create,
provide, operate, and develop . The activities should reflect the services described in the
PROGRAM DESCRIPTION (C2) .
Use the following elements to develop your outcomes. All elements must be included:
• Direction of change • Timeframe
• Area of change • As measured by
• Target population • Baseline: The number that you will be
• Degree of chane measuring against
Example 1 (Outcome) ,
To decrease (direction of change) number of unexcused absences (area of change) of enrolled
boys and girls (target population) by 75 % (degree of change) in one year (timeframe) as
reported by the 2003 School Board attendance records (as measured by). Baseline: 2003 School
Board attendance records for enrolled boys and girls.
Example 1 (Activity) :
To provide anger management classes to enrolled boys and girls 2 times a week for 12 weeks.
Example 2 (Outcome) :
75% (degree of change) of youth (target population) who have participated in the academic
enrichment activities (as measured by) for 6 months or more (timeframe), will improve
(direction of change) their scores in one or more subject area (area of change). 25 % of
participants in academic enrichment activities will maintain the initial level of performance
assessed at entry. Baseline: Pre-test scores from the academic enrichment test.
Example 2 (Activity) :
1 ) Provide pre and post-test exercises on the Advanced Learning System software; 2)
Participants will go through the one lesson per week and be graded for 10 weeks.
IMPORTANT NOTE :
Keep in mind when developing your PROGRAM OUTCOMES , that if funded, this will be what
you are held accountable to accomplish. Also, the PROGRAM OUTCOMES should reflect the
information described in the PROGRAM NEED STATEMENT (131 ).
All Program Need Statements should flow from the Mission & Vision. Measurable Outcomes
should be based on and measure program needs. Activities are the tasks you do that are going to
influence the outcome and impact the unacceptable condition in your Program Need Statement.
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D. MEASURABLE OUTCOMES (Entire Section D not to exceed two pages)
OUTCOMES ACTIVITIES
Add all ef the elements or the Measurable Outcomes Add the tasks to accomplish the Outcome(s)
OUTCOME #1 ACTIVITY # 1
Increase our 04 — 05 enrollment of 347 by 40% H. O.P. E. Academy will increase attendance by
for the 2006-2007 school year; and having the school administration give a
documented by the Informational Services of brochure about H.O.P .E. to each suspended
Indian River County School District. student and parent. We will give presentations
at PTA and SAC meetings as well as Student
Orientation days. In addition Hope Academy
will have a mass mail out of brochures or
letters with the title "Just In Case" to the
parents of the Middle and High Schools
students.
ACTIVITY # 2
OUTCOME #2
Teachers will log all assignments brought to us
In 06-07 school year 88 % of students attending by the student. They will supervise the student
H. O.P. E. Academy for the 2006-2007 school to make sure all assignments are completed.
year will return to school with their At the end of the students suspension the
assignments completed. Administrative Director will review
assignments and document the percentage of
assignments completed (scoring it 50%- 100%)
The student and parent will sign the document
before the student exits the program. (see
attachment 4)
OUTCOME #3
ACTIVITY #3 .
65% of our students will return to school with
improved anger management skills for the We will provide a pre-test administered
2006-2007 school year. immediately following their enrollment. A
qualified counselor will conduct our daily Rap
Sessions that addresses issues related to
behavior modification and life management
skills. On the student ' s final day the same test
will be administered to determine the students '
knowledge change of anger management.
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OUTCOME 94 ACTIVITY 44
Maintain the recidivism (re-suspension) rate at Students will attend class Rap Sessions that
less than 20% of the school year as recorded by focus on Anger Management, Good Choices
the School District Informational Services. vs. Bad Choices and Conflict Resolution Skills
(see attachment 2)
OUTCOME #5 ACTIVITY #5
Increase 06 — 07 numbers of parents attending We will conduct monthly workshops
HOPE monthly Parenting Class Breakfast coordinated by the Mental Health Association
Workshops by 60% of 04-05 end of the year of Indian River County. This will consist of a
enrollment of155 as documented 2 hour session on Effective Parenting.
by signed enrollment. Parents will be expected to attend at least one
session. Parents will receive a reminder notice
in the mail or a phone call reminding them of
their commitment to attend. Every attendee
will be required to sign an attendance form.
(see attachment 6)
OUTCOMES ACTIVITIES
Add all of the elements for your Measurable Outcome(s) Add the tasks to accomplish the Outcome(s)
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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. (See individual funder requirements for
inclusion of collaborative a reement letters.)
Collaborative Agency Resources provided to the program
Subsidize teachers salary, provides lunches,
1 . School District of IRC transportation, books and publications.
Classroom Spaces, and Recreational space at a reduce
2 . Gifford Youth Activity Center rate.
Gives weekly education and counseling on sexual
3 . IRC Health Department transmitted diseases and updated HIV statistics
4. Northside Agape Ministries Provides clerical and printing
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5 . Christine J. Pawloski, Inc . Tax Donate tax services quarterly and at the end of the year
6 . Mental Health Assoc . Donate counselor's fee for Parent Breakfast Workshops
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F. PROGRAM EVALUATION (Entire Section F not to exceed two pages)
1 . DEMOGRAPHICS : What information (data elements) will you need to collect in order
to accurately describe your target population including demographics (age, gender, and
ethnic background) required by the funder in Section H? What are the pieces of
information that qualify them for your target population ? How do you document their
need for services or their "unacceptable condition requiring change" from Section Bl ?
The statistics and reports on suspensions are our primary source of knowing our target
population.
The District Informational Services records the data on every suspended student and distributed
it to us . We have access to the student ' s basic information from our school site through TERMS .
This also enables us to identify our targeted population and their demographics; such as : number
of suspended student, why they were suspended, how many times they were suspended, etc . This
information is coordinated by the School District Head Statistician.
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?
1 . The Acknowledgement of Completion Sheet (attachment 4) is used to determine the
amount of assignments completed. The Director checks to see that assignments are
complete.
2 . The pre and post test for Conflict Resolution is used to determine behavior modification
(attachment 5)
3 . Yes, we do get base-line information from a collaborative partner, IRC School District.
The collaboration with the School District is used to provide the information needed for
the recidivism rates and general suspension data.
4. Some of the documentation data is processed bi-weekly, some every quarter and some
annually. We are required to make reports to the School District \supervisor of
Alternative Programs.
17
Edit this Header. Type the organization and program name and the funder for whom it is being completed. The page # is already set at the bottom right
of every page.
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?
Important information such as the origin, history, and the achievements will be compiled and
printed in "The Scope on H.O.P .E", which will also be used for a marketing correspondent.
In lieu or addition to this we will send out notice of updates to donors and or student' s parents
This information will be reviewed by the Director' s and Advisory Board.
The Administrative staff will evaluate what' s working or not
18
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of every page.
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.
Mnnth/Perind _ _ _ _ Activities _
■ Preparation for Staff Development Orientation Workshop
AUGUST ■ Staff Development Orientation Workshop
■ Classes Began
■ Monthly Board of Director' s Meeting Resumes
SEPTEMBER ■ Open House for District Administrators, Principals and
Teachers
■ Advisory Board Meeting
■ Monthly Parental Breakfast Resume
OCTOBER ■ Quarterly Evaluation Resume
■ Staff Development Workshop
■ Fund Raising Mail Out
■ Annual Board Meeting
DECEMBR ■ Advisory Board Meeting
■ Christmas Break
JANUARY ■ School Resume
■ Appeal to Parents
■ Advisory Board Meeting
MARCH ■ Donors Appreciation Dinner
JUNE ■ School Ends
■ Annual Inventory
■ Preliminary Planning for the next school year
JULY ■ Re-Evaluation of Preliminary Plans
19
Edit this Header. TvDe the organization and program name and the funder for whom it is being completed. The page # is already set at the bottom right
of every page.
Christmas Break
■ Advisory Board Meeting
20
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of every page.
H. PROJECTIONS FOR UNDUPLICATED CLIENTS
Number of Undu licated Clients by Location
«. p ' Current Fiscal Year �q
n a .Y.zP. '' �,a — `.- r t
Location ' Budget 2005/06ST
1 V 07
Unduplicated Clients Unduplicated Clients Unduplicated Clients
N. Indian River County 144 182 198
S. Indian River County 203 257 270
Indian River Co. Total 347 439 468
Greater Stuart - -
Hobe Sound - - -
Indiantown - -
Jensen Beach - -
Palm City - -
Martin County Total - - -
Fort Pierce - - -
Port Saint Lucie - -
St. Lucie Co. Total - -
Other Locations - - -
TOTAL SERVED 1 3471 439 1 468
Number of Unduplicated Clients by Age
� = Current Fiscal Year . _
Location "
Budget 2005/06
t�nl r gt? t {l1
i@ ,
yk14
Individual Group
0 to 4 - (Pre-school) - - - -
5 to 10 - (Elementary) 18 - 22 - 25 -
11 to 14 - (Middle) 140 191 - 205 -
15 to 18 - (High School) 189 226 - 238 -
Total Children 347 439 - 468 -
19 to 59 - (Adults) - 96 - 110 155
60 + (Seniors) - - - 24 -
Total Adults - 96 - 110 24 155
TOTAL SERVED 1 347 96 1 439 110 492 155
21
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of every page.
I. BUDGET FORMS - To open the Budget Forms, please double-click on the icon below.
s=
i =
" Core Budget Forms "
22
Type the Organization and Program Name
UNIFORM GRANT APPLICATION
BUDGET NARRATIVE WORKSHEET
IMPORTANT: The Budget Narrative should provide details to justify the amount requested in each line item of the budget for your
program. From this worksheet, your figures will be linked to the Total Agency Budget, Total Program Budget and Funder Specific
Budget Forms.
AGENCY/PROGRAM NAME : Project H .O . P . E , , Inc./ H . O. P. E. Academy .-
FUNDER : Advisory Committee- Indian River County
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 I
Abe used for calculations and to write information only.
ORRYMFOR
REVENUES A�R4aaeEgaoa�Y Proposed Total Program Funder Specific Total Agency
j"MD""" ` Budget Bud et
cucuuwm 9 Budget
1 Children's Services CouncilSt. Lucie
2 Children's Services Council-Martin
3 Advisory Committee-Indian River 99,550.60 99,550.60 99,550.60
4 United WaySt. Lucie County
5 United Way-Martin County
6 United We -Indian River Coun
7 Department of Children & Families
8 County Funds
9 Contributions-Cash 12,000.00 12,000.00
10 Program Fees
11 Fund Raising Events-Net 15,000.00 15,000.00
12 Sales to Public - Net
13 Membership Dues
11
14 Investment Income
15 Miscellaneous
16 Grants and Foundations 1 19,950.00 19,950.00
17 Funds from Other Sources 43,000.00 43,000.00
18 Reserve Funds Used for Operating 3,000.00 3,000.00
19 In-Kind Donations (Not included in total) 7,975.00 7,975.00
20 TOTAL REVENUES
(doesnl include line 19) $192,500.60
$99,550.60 $192 ,500.60
B D
EXPENDITURES egAYAMFOR Proposed Total Program Funders Specific Aaeaev use ordr P Total Agency
tsnaweALcuunoxst Budget Budget Budget
21 Salaries - (must complete chart on next page 141 ,260.00 80,400.00 141 ,260 .00
�Jlwl " UN
Salary
22 FICA - Total salaries x 0.0765 7.650% 10,606.00 6,150.60 10,806.00
e Iremen - nnua pension or qua i le
23 stag 1 ,400.00 0.00 1 ,400.00
Life/Health - e Ica enta o - enn
24 Disab.
Workers Compensation - emp ogees x 0.00
25 rate 5 employee o2,500.00 0.00 2,500.00
ri a nemp oymen - prolec
26 employees x $7,000 x UCT-6 rate 945.00 0.0 945.00
SALARIES A s v
Gross Annual C % of Gross Annual
POSITION LISTING Salary Portion of Salary on Proposed Funder S ec�c Bud
Position Title / Total Rrshvk (Agency) Program P get Salary
Requested(C(A)
Example. Execudve Dir tar/40hrs 70,000.00
sa4rzoos 10,000.00 5,000.00 7. 14%
e-1
Type the Organization and program Name
Example: Executive Director / 40 hrs 43,260.00 43,260.00 30,000.00 69, 35%
Administrative Assistant 40 Hrs. plus 22,000.00 22,000.00 12,000.00 54.55%
Clerical Staff Assistant 40 Hrs. 17,000.00 17,000.00 10,000.00 58.82%
Instructor # 140 hrs. 29,500.00 29,500.00 14,200.00 48. 14%
Instructor #2 40 hrs. Salary 29,500.00 29,500.00 14,200.00 48. 14%
#DIV/O!
#DIV/0!
#DIV/01
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/01
#DIV/01
#DIV/01
#DIV/01
#DIV/0!
#DIV/0!
#DIV/01
#DIV/0!
#DIV/0!
Remaining positions throughout the agency
Total Salaries $141 ,260.001 $141 ,260.00 $80,400.00 56.92%
FRINGE BENEFITS DETAIL A
(Funder Specific Budget Funder B c D E F G
Pension Worker's Unemployme Total Fringes Funder
Position Title / Total Hrshvk
Column C only, line 22 t0 27 specific FICA 7,65% Health Ins.y Budget (Ax %) Compens. nt Compens. Specific
Example: Case Manager/4ohrs 51000.00 382.50 200.00 500.00 300.00 200.00 1,582.50
Example: Executive Director / 40 hrs 30,000.00 2,295.00 2,295.0
Administrative Assistant 40 Hrs. plus 12,000.00 918.00 918.0
Clerical Staff Assistant 40 Hrs, 10,000001 765.00 765.0
Instructor # 140 hrs. 14,200.00 1 ,086.30 1 ,086.3
Instructor #2 40 hrs. Salary 14,200.00 1 ,086.30 1 ,086.3
0 0.00 0.00 0.0
0 0.00 0.00 0.0
0 0.00 0.00 0.0
0 0.00 0.00 0.0
0 0.00 0.00 0.0
0 0.00 0,00 o.5(
0 0.001 0.00 0 ,0
0 0.00 0.00 0.0
0 0.00 0.00 0.0
0 0.001 0.00 0.0
0 0.001 0.00 0. 0
0 0.00 0.00 0.6
0 0,001 0.00 0.0
0 0.001 6.00 0.0
0
0.001 0.00 0.0
Total Funder Request Fringe Benefits $80,400.001 $6, 150.60 $0.00 $0.001 $0.00 $0.00 $6, 150.6
A B C D
EXPENDITURES eMTq WE Lena Proposed Total Program Funder SpecificAGENCTotal Agency
axowerr Budget Budget Budget
27 Travel-Daily
# of Staff x average # of miles/wk x 50 wks x
$ = Estimated Daily Travel/Mileage Reimb.
28 Travel/Conferences/Training
vza¢oas
a-t
Type Ae Organ¢aWn and Pmgram Name
A B C D
EXPENDITURES meryaxu.raa Proposed Total Progr9500.(00
Funder Specific Total Agency
miaow un�iay� Budget Budget Budget
27 Travel-Dally 0.00 0.00
# of Staff x average # of miW*h* x 50 wks x $
= Estimated Daily Travel/Mileage Reimb.
28 TravegConferences/Tralning 0.00 500.00
• National Conference (cost per staff)
• Training/Seminar (cost per staff)
• Other Trainings (cost of travel, lodging, --- --
registration, food)
29 Office Supplies 5,200.00 3,000.00 5,200.00
• Office supplies (monthly average x 12 months
= estimated coat of office supplies based on
present history
30 Telephone 3,200.00 1 ,500.00 3,200.00
• # Phone fines x average cost per month x 12
months = local phone cost
• Average long distance calls x 12 months =
Estimated cost of long distance
31 POstagelSMppirg 700.00 400. 700.00
Special swarts,
• Quarterly Mailing of Newsletter Monthlyvents,
• Special events, etc. Curb raising
• Bulk mailings - appeals appeals
32 Utilities 0.00 0.00 0.00
• Electricity ($ x 12 months)
• Water/Sewer ($ x 12 months)
• Garbage ($ x 12 months)
33 Occupancy (Building & Grounds) Rental of our 10,364.00 0.00 10,364.00
is
• Mortgage/Rent ($ x 12 months) by thekly SS paid for
Di
• Janitorial ($ x 12 morift) chool
District. We s
• Grounds Maint. ($ x 12 months) Rental for our
• Real Estate Taxes warehouse
34 Printing & Publications 500.00 300.00 500.00
• Quarterly Newsletter ($ x 4)
• Letterheads, Envelopes, etc.
• Fundraising materials
• Dow
33 SubscrlptioNDues/Memberships 0.00 0.00 0.00
• Membership to National Organization
• Dues
• Subscriptions to Newspapers/magazines, etc.
36 Insurance 2,100.00 1 ,000.00 2,100.00
• Directors/OffiCers Liab. Workmen Comp
• Commercial/General Insurance Dire
• Bond Ins. Irmxaroe
• Auto Insurance Liability
37 EquipmeM:Rental S Maintenance 2,500.00 900.00 2,500.00
• Copier lease ($ x 12 months)
• Meter lease ($ x 12 months)
• Copier Maintenance ($ x 12 months)
• Computer Maintenance ( $ x 12 months) Comer Lease
• Other Agreement .
38 Advertising 700.00 0.00 700.00
• Newspaper ads
• Fundraising ads/promotions
• Other (vacancies)
38 Equipment Purchases:Capital Expense 1 ,000.00 0.00 1 ,000.00
szsaocx B1
Type the Organization and Program Name
• Computer/monitor (M x $)
• Laser Printer
40 Professional Fees (Legal, Consulting) 1 ,800.00 700.00 1 ,800.00
• Legal advice ( estimated ihrs x $)
• Consultant fees
• Other
41 Books/Educatlonal Materials books are 350,00 0.00 350.00
• Bookshxleos supplied by the
• Materials ($ x staff) School District
42 Food 8 Nutritlon supplies our 0.00 0.00 0.00
• Meals ( / meals x clients x 5days x 50 Wks) meals for
• Snacks students
43AdministrativeCosts 0.00 0.00 0.00
• Admin. Cost (% of total budget)
44 Audlt Expense 3.800.00 1 ,000.00 3.800.00
• Independent Audit Review
45 Specift Assistance to Individuals 250.00 100.00 250.00
• Medical assistance We will be
• Mealwfood giving our
students things
• Rent Assistance
to motivate them
• Other to aspire
46 Other/Miseellaneous 500.00 10000 500.00
• Background check/drug test
• Other
47 /Contract 800.00 0.00 800.00
Subcontract for program services
48 TOTAL EXPENSES $191 ,175.39 $55,550.60 $isl .t7s.3s
61
T� ,, �w�
UNIFORM GRANT APPLICATION
TOTAL AGENCY BUDGET
AGENCYIPROGRAM NAME:
FY 0406 FY 03106 FY 06107 % INCREASE
FYE FYE CURRENTVS.
NEXT FY BUDGET
A B C D
ACTUAL TOTAL PROPOSED lar O<ot syw a
REVENUES BUDGETED BUDGETED
1 Children's Services CouncilSt Lucie 0.00 #DIV/01
2 Children's Services Council-Martin 0.00 #DMO!
3 Advisory Committee-Indian River 9975100 9996500 9955700 -0-41 %
4 United Way-St Lucie County 0.00 #DIV/o!
5 United Way-Martin County 0.00 #DIVro!
6 United Way-Indian River County 0.00 0.00 O.oO #DMO!
7 Department of Children & Families 0.00 #DIVIO!
a CountyFunds 0.00 #DMO!
9 Contributions-Cash 7 245.00 12 865.0012,000.00 -6.72%
III Program Fees 0.00 #DIV/O!
11 Fund Raising Ev ts,*et 61648.67 10 000.00 15 000.00 50.00%
12 Saks to Public-Net 0.00 #DIV/O!
13 Membership Dues 0.00 #DIVIO!
14 lnvesmKntincome 0.00 #DIV/O!
15 Miscellaneous 0.00 #DIV/O!
is Grants and Foundations 21 t679.00 20 50.00 19 950.00 -1 .48%
17 Funds from Other Sources 40A15.00 41 740.00 43.000.00 3.02%
1a Reserve Funds Used for Operating 2966.00 61000.00 3000.00 40.00%
19 In-IGrM Donations stw ne4.4.4 nte.0
7,863.00 81463.00 797600 5.77%
m TOTAL 179 211 .57 189 820.00 192,507.00 1 .42%
EXPENDITURES
21 Salaries 12"60.00 138000.00 141 ,260.00 1 .637
22 FICA 8668.68 10638.60 10,606.39 1 .58%
23 Retirement 0.00 1600.00 1 ,400.00 -12.50%
w Lifen4with 0.00 0.00 0.00 #DIV/O!
25 Workers Compensation 3,260.00 1 Aw.00 27500. 78.57%
26 Florida Unemployment 945.00 84600 945.00 11 .83%
27 Travel-Dally 0.00 0.00 0.00 #71V70!
29 TravellConferences/Trainin 894.85 600.00 500.00 0.00%
29 Office Supplies 4,362.18 4 600.00 5,200.00 13.04%
30 Telephone 3 758AB 39600.00 3,200.00 -8.57%
et P013tagelShipping873.61 700.00 700.00 0.00%
32 Utilities 0.00 0.00 0.00 #DIV101
33 Occupancy (Building & Grounds 11 865.80 1036400 10,364.00 0.00%
34 Printing & Publication 440.78 1 .000.00 500.00 60.00%
35 Subscri tionlDues/Membershi 0.00 0.00 0.00 #DIV/O!
3s Insurance 1 ,112.18 2100.00 210000 0.00%
37 E ui m Nrt•Rental B Maintenance 22476.08 2,200.00 2,500.00 13.6%
Be Advertising 1 A47.39 500.00 700.00 40.00%
39Equipment Purchases:Capital Expense 920.61 200.00 1 ,000.00 400.00%
40 Professional Fees (Legal, Consuld 2076.00 2000.00 1 ,800.00 -10.070R.
41 Books/Educational Materials 151.77 200.00 350.00 75.00%
Q Food & Nutrition 0.00 0.00 0.001 #DIV/O!
43 Administrative Costs 0.00 0.00 0.00 #DIVro!
a Audit Expense 3.600.100. 370000 3,800.00 2.70%
45 Specific Assistance to Individuals 304.35 200.00 250.00 25.00%
46 Other/Miscellaneous 526.29 600.00 500.00
47 OthedCOntract 261A4 900.00 800.00
49 TOTAL 177,183.49 186,647.50 191 ,175.39
49 REVENUES OVE UNDER EXPENDITURES 2,028.08 3,172.50 1 ,331 .61 68.03
rsnvaos e.x
T�ft
UNIFORM GRANT APPLICATION
TOTAL PROGRAM BUDGET
AGENCYIPROGRAM NAME:
FY 04105 FY 03M FY DW7 % INCREASE
FYE FYE FYE CURRENT VS.
NEXT FY BUDGET
A B C D
ACTUAL TOTAL PROPOSED 1� t<al aywle
REVENUES BUDGETED BUDGETED
1 Children's Services Council-St Lucie 0.00 #DIVl0!
2 Children's Services CouncibMartin 0.00 #DIVIO!
3 Advisory Commtltee-indian River 99 751 .00 99 966.00 99,557.00 -0.41 %
4 United Way-St Lucie Countv 0.00 #DIV/D!
5 United Way-Martin County 0.00 #DIVIO!
s United Wa -Indlan River County 0.00 0.00 0.00 #DIV101
7 Department of Children 8 Families 0.00 #DIVIO!
s County Funds 0.00 #DIV/O!
9 ContributienaCash 7245.00 12865.00 12,000.00 5.72%
i0 Prooram Fees 0.001 #DIVIO!
11 Fund Raisft Events-Net 6 "BA7 1000000 12,000.00 20.00%
12 Saks to PuMic-Net 0.00 #DIVIO'
is Membership Ives 0.00 #DIVIO!
44 Investment Income 0.00 #DIVIO!
15 MIsCeRSHIMO S 0.00 #DIVfC!
is Grants I Foundations 21 679.00 20 250.00 19,950.00 -1 .48
I? Furls from Other Sources 40 15.00 41 740.00 43,000.00 3.02%
is Reserve Funds Used for ;�'xrating 21965.00 5000.00 37000.00 -40.00%
Is In-Kind Donations oft , In tw0 7863.00 8.463.001 7,975.00 5.77%
20 TOTAL 178 693.57 189 820.00 189,507.00 -0.16%
EXPENDITURES
21 Salaries 128 250.00 139 000.00 141 ,260.00 IAN/.
22 FICA 9 668.68 1063850 1060639 1 .58%
23 Retirement 0.00 1 ,600.00 1 ,400.00 -12.50%
24 LifeMealth 0.00 0.00 0.00 #DIV/0!
2s Workers Compensation 9 260.00 1 A00,00 2,500.00 78.57%
2s Florida Unemployment 945.00 845.00 945.00 11 .83%
27 Travel-Oally 0.00 0.00 D.00 #DIVIO!
2a TraveVConferencesfTraml 894.00 600.00 500.00 0.00%
29 Office Su fes 4 G00,00 5,200.00 13.04%
30 Te 3 758A8 3j600,00 3,200.00 -8.57%
31 Postage/Shipping873.61 700.00 700.00 0.00%
32 Utilities 0.00 0.00 0.00 #DNIO!
33 Occupancy (BuildingS Grounds P4,368.18,
1 865.80 10 3".00 10,364.00 0.00%
34 Print) 8 Publications 440.78 1 000.00 600.00 50.00%
as Subscri tionlDues/Membershi 0.00 0.00 0.00 #DIVIO!
361nurante 1112.18 2100.00 2,100.00 0.00%
37Eui ncRental 8, Maintenance 2,476.08 2700.59 2,500.06 -7.41 %
se Advertising 1 A47.34 500.00 700.00 40.00%
se Equipment Purchases:Ca "tal Expense 920.61 200.00 1 000.00 400.00%
4O Professional Fees (Legal. Consulting) 2075.00 2000.00 11800.00 -10.00%
M BooksMducational Materials 151 .77 200.00 360.00 75.00%
42 Food 8 Nutrition 0.00 0.00 O.Do #DIVIO!
43 Administrative Costs 0.00 0.00 0.00 #DIVIO!
44 Audit Expense 3,600.00 3,700.00 3,800.00 2.700/6
45 Specific Assistance to IndhAdu s 304.35 200.00 250.00 25.000/6
46 OtherlMiscellaneous 525.29 500.00 500.00 0.00%
47 OtherX tract 261 .14 900.00 800.00 -11 .11 %,
4a TOTAL 177188.59 187147.50 191 ,175.39 2.15%
49REVENUES OVERIUNDER EXPENDITURES 1 .98 2672.60 -1 9 -162.43%
,568.3
reran w
TWe ft CW=kn mit PruWx Nems
UNIFORM GRANT APPLICATION
FUNDER SPECIFIC BUDGET
PROGRAM EXPENSES
AGENCY/PROGRAM NAME:
FUNDER: A B C
FY 06/07 FY 06/07 % OF
TOTAL FUNDER TOTAL VS.
PROGRAM SPECIFIC FUNDER REQUEST
BUDGET BUDGET cd. Blvd. A
EXPENDITURES
21 Salaries 1419260.00 803400.00 56.92%
22 FICA 109806.39 6,150.60 56.92%
23 Retirement 11400.00 0 .00 0.00%
24 Life/Health 0.00 0 .00 #DN/O!
25 Workers Compensation 23500.00 0.00 0.00%
26 Florida Unemployment 945.00 0.00 0.00%
27 Travel-Daily 0.00 0 .00 #DIV/0!
28 Travel/Conferencesfrrainin 500.00 0 .00 0.00%
29 Office Supplies 5,200.00 31000 .00 57.69%
3o Telephone 31200.00 17500 .00 46.88%
31 Postage/Shipping 700.00 400 .00 57.14%
32 Utilities 0.00 0.00 #DIV/0!
33 Occupancy (Building & Grounds 10,364.00 0.00 0 .00%
34 Printing & Publications 500.00 300.00 60 .00%
35 Subscription/Dues/Memberships 0.00 0.00 #DIV/01
361nsurance 2,100.00 11000.00 47.62%
37 E ui ment:Rental & Maintenance 23500.00 900.00 36.00%
38 Advertising 700.00 0.00 0.00%
39 Equipment Purchases :Ca ital Expense 1 ,000.00 0.00 0.00%
40 Professional Fees (Legal, Consulting) 11800.00 700.00 38.89%
41 Books/Educational Materials 350.00 0.00 0.00%
42 Food & Nutrition 0.00 0.00 #DIV/O!
43 Administrative Costs 0.00 0.00 #DIV/0!
44 Audit Expense 39800.00 11000.00 26.32%
45 Specific Assistance to Individuals 250.00 100.00 40.00%
46 Other/Miscellaneous 500.001 100.001 20.00%
47 Other/Contract 800 .00 0.001 0.00%
48 TOTAL $191 ,175.39 $95,550.60 49.98%
MUM 04
UNIFORM GRANT APPLICATION
EXPLANATION FOR VARIANCES OF 15% OR MORE
FUNDER SPECIFIC BUDGET
AGENCYIPROGRAM NAME:
FUNDER:
UNE ITEM EXPLANATION FOR VARIANCE
The difierecnce in th salaries is What must be paid and what vve are able to get for the advisory committee. You are ony Funding a
$111larms p~ of the salaries.
FICA
SDAMX Once again the difference reflect what is the total cost versus what We are able to get from C S.
swim
SUDDIleS Same as above. It cost more to do eveithirij, yet funding is limited.
Telephorte Same as above. It cost more to do eveythina, funding is limited.
PostiatitiShicialm
Same as above. it cost more to do ereything, yet funding is limited. We are doing more mail out as well; that's to students and
ential donors.
Iltabons
We areasking for less than what we possiby will need. Madeefing is veal to the confinuetl success of HOPE and that mile for more
printing'and publicity. We find that there are a great number of parents and ctmens that yet doesnY Imow about the benefits of HOPE
Irrmmrrce
EaulorriefftRefftal & Maintenance Same as above This is the potential cost and yet vve can mly request for so much.
Pr lona) Fees IlLecial. Consultlml The cost versus the funding.
IW
Audit Eigasirse Cost versus funding
Siwific Asslsfance to Individitals Cost versus funding
Cost versus funding
smnor sa
UNIFORM GRANT APPLICATION
EXPLANATION FOR VARIANCES OF 15% OR MORE
HINDER SPECIHC BUDGET
AGENCYIPROGRAM NAME:
FUNDER:
LlNE ?EM. . . EXPLANATION FOR VARIANCE
The dilferecnoe in th salaries is what must be paid and what we are able to get for the advisory committee. You are only funding a
salaries portion of fhe salaries.
FIG
M] b! Once again the ddfemnce reflect what is the total cast versus what we are able to got from C 5.
Office supalles Same as above. It cast more to do eveything, funding is limited.
Telephone Same as above. It cost more to do eveything, yet funding is limited.
PostacelShloolm
Same as aboveit cost more to do eveything, yet funding is limited. We are doing more mail out as well; Maes to students and
WIV101 priential donors.
Prinflna & Publications
Weare asking for less than what we possibly will need. Madoeting is vital to the continued success of HOPE and that calls for more
pnntinjand publicly. We find that Mere are a great number of parents and oit¢ens that yet doesnY know about the benefits of HOPE
Academy.
Inwrarice
EaularnigntRental 8 Maintenance Same as above. This is the potential cost and yet we can only request for so much.
Pr tonal Pori al The cost versus the funding.
M)NIO-1
omm
Aud Cost versus funding
$nectfic AssislIance to Individmis Cost versus funding
r Cost versus funding
naarmor u
UNIFORM GRANT APPLICATION
EXPLANATION FOR VARIANCES OF 15% OR MORE
TOTAL PROGRAM BUDGET
AGENCYIPROGRAM NAME:
FUNDER:
LIMEfTEM. EXPLANATJON FOR VARIANCE
NWO
roIW01
ODIVM
row
SMAH
xmlw
XDNAH
Our 0405 Fund Rasing Event was the first annual dinner used to raise funds Although the last two did not meet our expectatons R
has proven to be the best fund raising event we've used. This coming year we are kroldng to exceed both 04-05 and 05-06 because
FuW Ralsimwe have an Professional Event Maker/Marketer committed to work with our Donors Appreciation Dinner.
101
rowlol
fm
The carrier we had in previous years stop provicing Work Compensation. Sid Banak could not find a oommemial Cartier that was will
to give us coverage. Therefore we had to get coverage from the effete; who IReraly charged us twoe as much as we were usually
Workers Commnsallim Daying. Hw.ever, our booldmeper wove able to find a carder out o f Orlando who we vhll cover our 06-07 fiscal year.
!01
ADVVM
raves
AdveMshm Our ad edisement was more bemuse of ads taken I n press journal to solicit em for vatous positions.
Enuiacnaird Purchases:Ce I
We did not inticipate purchasing morecomputers. Sincewe had funds in our treasure "air-marked' for computers only and there
arosed a desperate need, we purchased one.
We have rot made a large puchase of books or Hdeos recenty. Ho , we have to plan to possible do more this ywr ff a do not
ucetlona atez receive donated materials from the School District.
amm
81MAN
This area of funding include the things we do for the students parents. It is really connected with our student incentive budget. We
Sl Ismnce to Individuals hae group rneetings once every month with incentives to get people to come. This year things cost more'
amrmoe a'
UNIFORM GRANT APPLICATION
EXPLANATION FOR VARIANCES OF 15% OR MORE
TOTAL PROGRAM BUDGET
AGENCYIPROGRAM NAME:
FUNDER:
LINE/TEM. I - E.)LANATION FORVAR/ANCE
#DIVM
MIM 1
mma
/01
# M
OMMI
Our 04-05 Fund Raising Event was the first annual dinner used to raise funds. Although the last two did not meet our expectaions it
has proven to be the gest fund raising event we've used. This coming year we are looking to exceed both 04-05 and 05-06 because
Fund Ralalm Events~ we have an professional Event Maker/Marketer committed to work with our Donors Appreciation Dinner
01
AKMWI
SONM
swim
p!
The comer we had in previous years slop Vwidng Work Compensation. Sid Banak could not find a commercial prier that was w111
to give us coverage. Therefore we had to get covemge from the shote; who literally charged us twice as much as we were usually
Workers Cormsensistion paying. Hovevef, our booldoeeperwere able to find a prier out of Orlando who we vAA cover our 06-07 fiscal year,
1114"M
inwim
Adverdsim Our advertisement was more because of ads taken I In mal to solicit employees for vaious posftxxns
ul
We did not inticipate purchasing more computers. Since we had funds in our treasure "air-marked" for computers only and there
arosed a desperate need we purchased one.
We have not made a large puchase of books or videos recently. Hcever, we have to plan to possible do more this year if we do not
Books/Mucartional Materials receive donated materials from the School District.
owmi
This area of funding Include the things we do for the students parents. It is really connected with our student incentive budget. We
Specific Assistance W IndIvIduathshas group meetings once e%rery month with incanfi a to geit people to come. lTle year things cost more
envmor �+
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 sian this form will result in disaualification
Handwritten Signature of Authorized Principal(s): DATE: 05-23-2006
NAME: Henry Burson, Jr
TITLE : Chairman of Board
NAME OF FIRM/PARTNERSHIP/CORPORATION :_ H . O. P . E . Academy
Sworn to and subscribed to FOR AND ON BEHALF OF THE APPLICANT:
me, a Notary Public, this
_23_day of —MAY., 2006. BY: H O P E ACADEMYI�,= ` .
Henry Burson , Jr.
Chairman of Board
(TYPE NAME & TITLE)
s aGO�M t 10,2 '0i:
•� 5
�p`•. '�5 #D,gD345501 : r
O
XI
AUTHORIZATION FOR RELEASE OF INFORMATION
Indian River County and Project H . O . P . E. , Inc. (Agency/Individual
are in the process of negotiation of a contract for _Hope Academy
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 _Project H. O .P . E. , Inc.
Name Employee Providing au horization _Henry Burson , Jr.
' t name
Signature (in blue ink)
Date 05-23-2006
aoo anssoi a o=
.04*6lK
XiI
SWORN STATEMENT UNDER SECTION 105. 08,
INDIAN RIVER COUNTY CODE, ON DISCLOSURE OF RELATIONSHIPS
THIS FORM MUST BE SIGNED IN THE PRESENCE OF A NOTARY PUBLIC OR
OTHER OFFICER AUTHORIZED TO ADMINISTER OATHS .
1 . This sworn statement is submitted with RFP No. 2006061 for _H . O . P. E . Academy
2. This sworn statement is submitted by: -Project H . O . P. E.
Henry Burson , Jr. =
( Name of entity su mittin Statement)
whose business address is :
4875 43" Avenue , Vero Beach , FL 32967 and
(if applicable )
its Federal Employer Identification Number (FEIN) is_59-3739693
( If the entity has no FEIN , include the Social Security Number of the individual signing
this sworn statement
3. My name is Henry Burson , Jr.
(Please print name of individual signing)
and my relationship to the entity named above is _Chairman of Board
4. I understand that an "affiliate' as defined in Section 105. 08 , Indian River County
Code, means :
The term "affiliate" includes those officers, directors , executives, partners, shareholders,
employees, members , and agents who are active in the management of the entity.
5. 1 understand that the relationship with a County Commissioner or County employee
that must be disclosed as follows:
Father, mother, son , daughter, brother, sister, uncle, aunt, first cousin ,
nephew, niece , husband , wife , father-in-law, mother-in-law, daughter-
in-law, son-in-law, brother-in-law, sister-in-law, stepfather, stepmother,
stepson , stepdaughter, stepbrother, stepsister, half brother, half sister,
grandparent, or grandchild .
6. Based on information and belief, the statement, which I have marked below is true in
relation to the entity submitting this sworn statement. [Please indicate which statement
applies .]
XIII
_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,-executiyes,-{partners;shareholders , employees; members,eragents,
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
XIV
(signature)
05-23-2006
(date)
STATE OF Florida
COUNTY OF Indian River
The foregoing instrument was acknowledged before me this _23_ day of
—May_, 2006 , by _Henry Burson , Jr. who is personally
known to me or who has produced Dr. License as
identification .
NOTARY LIC
SIGN :
PRINT: _Brenda Jones
State of Florida at Large
My Commission Expires:
(Seal)
`\``pOP�NDA JOiyFSG�i'i
pMissiotiF
S X110. 2 k° i
*DD 345501 < x
g.
*;/j V940000
lllllll
XV
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 251" Street
Vero Beach , Florida 32960-3365
Recipient: H .O. P. E . Academy
4875 43rd Avenue
Vero Beach , Florida 32967
2 . Venue: Choice of Law. The validity, interpretation , construction , and effect of this
Contract shall be in accordance with and governed by the laws of the State of Florida
only. The location for settlement of any and all claims, controversies, or disputes , arising
out of or relating to any part of this Contract, or any breach hereof, as well as any
litigation between the parties, shall be Indian River county, Florida for claims brought in
state court, and the Southern District of Florida for those claims justifiable in federal court.
3 . Entirety of Agreement. This Contract incorporates and includes all prior and
contemporaneous negotiations, correspondence, conversations, agreements , and
understandings applicable to the matters contained herein and the parties agree that
there are no commitments , agreements, or understandings concerning the subject matter
of this Contract that are not contained herein . Accordingly, it is agreed that no deviation
from the terms hereof shall be predicated upon any prior representations or agreements ,
whether oral or written . It is further agreed that no modification , amendment or alteration
in the terms and conditions contained herein shall be effective unless contained in a
written document signed by both parties .
4 . Severability. In the event any provision of this Contract is determined to be
unenforceable or invalid, such unenforceability or invalidity shall not affect the remaining
provisions of this Contract, and every other 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 -
Oct 31 06 08 : 05a P , 2
x-1 . 0 . P. E. ACADEMY
t An Alternative Program for Suspended Students
'- Gifford Youth Activities Center
4575 43rd Avenue . Vero Beach , FL 32967
telephone: ( 772) 562-4325 , Fax: ( 772) 562-6965
Shekina Michelle, Executive Director • Henry Burson, Jr- erd lianicurtis W. Burson, Founders
October 29, 2000
To Whom It Mav ('uncurn :
IQPL:
A0 . CERTIFICATE OF LIABILITY INSURANCE DATE o
PRODUCER PIDnE (ITZ) M4SW FK (T7.1) 'W24&IB6
HILO ROGAL & HOBBB OF FLORIDA, INC. - VERO BEACH ONL7 CERTIFICATES ISSUED RIG TS A MATTER OF INFORMATION
ONLY R. CONFERS NO TE DO UPON THE D, EXTEND
204614TH AVE. /]OLDER. TMt4 CERTIFICATE GOES NOT AMEND, EXTEND OR
P 0 BOX 130 ALTER THE COVERAGE AFFORWO BY THE POLICIES BELOW.
VERO BEACH FL 32161
INSURERS AFFORDING COVERAGE NAIC B
INSURED — ... INSURERA: AUTO OWNERS INSURANCE ___ _.. .. .._.
PROJECT H.O.P.E., INC. INSURER e: FbAdB WoNkB/B CampEnsatlon JUA, Inc.
4876 43RD AVENUE —
VERO BEACH FL 32847 iINSURER C:
IINSURER D:
INSURERE:
COVERAGES
THC POLICIES OP INSURANCE LISTED BELOW RAVB BEEN IBSUBO TO THE WSUWD NAI ABOVE FOR THE UCYPERgO WDID,ATED, NOTWMUTANDOG
ANY REOUIREAENT. TORN OR CONDTIONI OF ANY CONTRACT OR OTHER OOCUMEFT WTN RESPECT TO WHICH TMS CERTIFICATE ANY BE ISSUED OR
MAY PERTAMI, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TEAMS, EXCLUSONB AND CONORDNS OF SUCH
POLICIES. AGGREWTELMUE SOWN NNY HAVE BEEN REDUCED BY PND CUBA
LTR TYPE OF N4URANCE POLDYNUMBER PONEYBfNECI1VE PLIICY BORATgN LINTS
GENERAL UARRm 002312.206N73240 09104104 0810M07 EACH a NCE T 1 ,000,000
MCOMMERCIAL GENERAL LIABILITY]
PBoau IDL GIrG.GrT.I
CLANG MADE I X Il7CCLA1 nEo. EXa (A,ryw,Nperwn) { 6.000
; PERBONALSADVIWURY 3 1,000,000
GENORAI AGGREGATE f __ 11000,000
CENL AGGREGATE LOST APPlIE6 PER: PRODUCTS-CONB•IpI AGG S 1 ,000,000
POLICY JECT 0LOC
AUTOMOBILE LIABILITY
COMBINED SINGLE±LWIT =ANYAITO � (Ee ATJ/N4NALL OWREDATOsBODILYSCHEDULED ALTOS IPN Persm)HIRED
AUTOSAUTOSBp 01Ly yJ�RrPnOPERT' DAN 'G
Pe AmanA
GARAGE UAMLRY 1
ANYALTO AUTO ONLY • EA ACCIDENT , _}t_ .. _. _. _ ... _
OTHERTHAN EAACO S
AUTO ONLY: AGG i —.. _ . __.. . . . .
ERCEN I UMBRM.LA LIABILITY EACH OCCURRENCE i
' OCCUR El CLANS MADE AGGREGATE .--.._._.. .
3
I ! -
OEDUCTIBL.E i
RETENTION S __ .. . . .. .
t
;WORKERS COMPENSATION AND OFR13US4211069-0-06 0&28106 MNOT TM�rA, aneA
F— .__. ..
g Axr PllwwEroBPAATNBBIB!eNNE E,L. EACHAOCIDENT ! 10Q000
E.4 NSEASEEA RWLOYEEt
"BOft FAOFNIORP AGNS E.L. OBFASEPp,p;r LMRT - `___ . .._-600,000
OTHER
i
DEBCRIPTON OF OPERATIONSROCATN)NBNEHICLES/El(CLUSIGNS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POUCES BE CANCELLED BEFORE THE
OXPRIATCN DATE THEREOF. THE IMBUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS
WRfRFN NOTICE TO THE CERTIFICATE NOLOER NAMED TO THE LER, BUT FAILURE
7000 SO SHALL WOBE NO OBLIGATION OR LMBILITY OF ANY RING UPON THE WSURER
INDIAN WISER COUNTY
IRAQ 26TH STREET AEITS AGENTS OR REPRESENTATB.
VERO BEACH, FL 32840 AUTINORT(ED IEPRESENTAIIVE
Attention: T7246"m Idrnry
ACORD 26 (2001108) CertifinlB S 99713 GACORD CORPORATION 1868
CHILDREN 'S SERVICES ADVISORY COMMITTEE
C/O Human Services
1840 25`h Street
Vero Beach, Florida 32960-3394
Phone: 561 -567-8000 (Ext. 1467 or 1524)
Fax: 978-1798
E-Mail Mmasterson(aDircgov com
To: Beth Jordan
Risk Management
From : Marion Masterson
Department Head :
Date : November 2 , 2006
Re: Contracts for 2005/06 Funding Year — HOPE Academy
Attached are two copies of the contract and Proof of Insurance for each of the programs.
Please let me know if this is not the case; and as always , if acceptable , circulate .
Thank you .
This is not an agenda item .
A
p ro iDate
Administrator
Risk
t,
Indian River Legal
Budget
De artment
FAHuman Service \Marion\My Documents\RFP 2006061 2006-0TMEMO TO RISK MANAGEMENT.doc