HomeMy WebLinkAbout2006-331I. 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 St to of Florida ; 1840 251h Street, Vero
Beach , Florida , 32960-3365; and Gifford Youth Activity Center (Recipient), of:
Gifford Youth Activity Center
487543 rd Avenue
Vero Beach , Florida 32967
Summer Cultural Camp 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 : TWENTY SEVEN
THOUSAND, DOLLARS ($27 ,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, &
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'(xO INTY BOARD t!F COMMISSIONERS
By: r _
Arthur fiberq firman
BCC Approved : Q(/
Attest: J . K. Barton, Clerk
By:
Deputy Clerk
Approved (1 CK r
Jose h A. Baird
County Administrator
Approved as to form and legal sufficiency:
By. i / —
rian E . Fell, Assistant county Attorney
RECIPIENT : o - n -
By: ��L� �C I&J
Gifford Youth Activity Center
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EXHIBIT A
(Copy of complete Request for Proposal)
EXHIBIT - A -
ORGANIZATION: GIFFORD YOUTH ACTIVITY CENTER
PROGRAM: SUMMER CULTURAL CAMP
FUNDER CHILDREN'S SERVICES ADVISORY COMMITTEE
PROGRAM COVER PAGE
Organization Name: Gifford Youth Activity Center
Executive Director: Michael Hubler E-mail:mhublerratgvac . cc
Address : 4875 43 `d Avenue Telephone: (772) 794- 1005 Ex. 22
Vero Beach, FL 32967 Fax :(772) 569-5563
Program Director: Paul Baker E-mail : pbakera) evac. cc
Address : 4875 43 `d Avenue Telephone: (772) 794- 1005
Vero Beach, FL 32967 Fax: (772) 569-5563
Program Title: Summer Cultural Camp
Priority Need Area Addressed: Mental Wellness: Childcare Access
Brief Description of the Program: The Summer Cultural Camp utilizes the talents and expertise of the
Vero Beach Museum of Art and the Riverside Children' s Theatre to economically provide high quality
instruction of visual and dramatic arts. The Camp emphasizes the arts through the use of team
work and visual and performing arts. The programs of the Camp also reinforces the six pillars of
Character Counts. Taxonomy Definition — Arts and Crafts Instruction.
SUMMARY REPORT — (Enter Information In The Black Cells Only)
Amount Requested from Funder for 2006 /07 : $ 305000 . 00
Total Proposed Program Budget for 2006 /07 : $ 40 , 669 . 50
Percent of Total Program Budget : 73 . 80o
Current Program Funding ( 2005 /06 ) : $ 28 , 800
Dollar increase / (decrease ) in request : S 1 . 200
Percent increase/( decrease) in request * * 4 . 2 %
Unduplicated Number of Children to be served Individually : 185
Unduplicated Number of Adults to be served Individually : -
Unduplicated Number to be served via Group settings : -
Total Program Cost per Client: 219 . 84
* * If request increased 5% or more, briefly explain why:
If these funds are being used to match another source, name the source an, d /the $ amount:
om
The Organization 's Board of Directors has approved this apphcati n (date).
John H. Dean
Name of President/Chair of the Board signa
Michael S. Hubler ^ I
Name of Executive Director/CEO
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ORGANIZATION : GIFFORD YOUTH ACTIVITY CENTER
PROGRAM: SUMMER CULTURAL CAMP
FUNDER: CHILDREN' S SERVICES ADVISORY COMMITTEE
ORGANIZATION: THE GIFFORD YOUTH ACTIVITY CENTER
PROGRAM: SUMMER CULTURAL CAMP
TABLE OF CONTENTS
Please "X" the parts of the grant application to indicate that they are included. Also, please put the page number where the information
can be located.
X Section of the Pro osalI Pa e #
X TABLE OF CONTENTS (check list) 1
X COVER PAGE (with signatures) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
X A. ORGANIZATION CAPABILITY (one page maximum) 4
X 1 . Mission and Vision of organization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
X 2 . Summary of expertise, accomplishments, and population served . . . . . . . . . . . . . . . . 4
X B. PROGRAM NEED STATEMENT (one page maximum) 5
X 1 . Program Need Statement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . 5
X 2 . Programs that address need and gaps in service . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
X C. PROGRAM DESCRIPTION (two pages maximum) 6
X1 . Funding priority . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . 6
X 2 . Description of program activities . . . . . . . . . . . . . . . . . . . . . . . . 0 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
X 3 . Evidence that program strategy will work. . . . P . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
X4 . Staffing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . 4 . . . . . 7
X 5 . Awareness of program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P . . 4 . . . . . . . . . . . . . . . . . . . .
. . 7
X 6 . Accessibility of program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . 7
X D. MEASURABLE OUTCOMES (two pages maximum) . . . . . . 0 . . . . . . . . . . . . . . . . . . 8
X E. COLLABORATION (one page maximum) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
X F. PROGRAM EVALUATION (two pages maximum) 11
X1 . Demographics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . 11
X2 . Measures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . 11
X3 . Reporting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . 11
X G. TIMETABLE (one page maximum) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
X H. UNDUPLICATED CLIENT COUNT 13
X 1 . Projections by Location . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 . . . . . . . . . . . . . . . .
. . . . . 13
X 2. Projections by Age Group . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . 13
X I. BUDGET FORMS 14
X 1 . Financial Budget Forms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . 14
1
ORGANIZATION : GIFFORD YOUTH ACTIVITY CENTER
PROGRAM: SUMMER CULTURAL CAMP
FUNDER: CHILDREN'S SERVICES ADVISORY COMMITTEE
J. FUNDER SPECIFIC/ADDITIONAL SHEETS
K. APPENDIX
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ORGANIZATION : GIFFORD YOUTH ACTIVITY CENTER
PROGRAM: SUMMER CULTURAL CAMP
FUNDER: CHILDREN 'S SERVICES ADVISORY COMMITTEE
PROPOSAL NARRATIVE
A. ORGANIZATION CAPABILITY (Entire Section A not to exceed one page)
1 . Provide the mission statement and vision of your organization.
GYAC Mission Statement is:
With God' s guidance our vision is to establish a partnership among youth, adults and the
Gifford-Indian River County area that develops self-esteem, teaches character and encourages
each individual to his/her ultimate potential .
GYAC Vision is :
To provide supplemental educational and character enhancing visual and dramatic arts
opportunities to children and families in the Gifford-Indian River Community to enhance their
educational and personal growth and development. In doing so, it is the GYAC ' s charge to
enhance our children and families ' educational and professional success. Skills learned in these
programs are directly transferable to success in educatiop and life include: responsibility,
discipline, respect, teamwork, caring and sharing.
2. Provide a brief summary of your organization including areas of expertise,
accomplishments, and population served.
The GYAC was established in 1998 to meet the educational and personal development needs of
the Gifford-Indian River Community through supplemental children' s education and family
development opportunities . The GYAC has also established a network of programs to enhance
behavioral outcomes of these children. The GYAC employs educational experts and partners
with many organizations to provide these services. The GYAC has utilized the expertise of
partners including: the Indian River County (IRC) School District, the Indian River Community
College, Project Hope, Indian River Library System, the Cultural Counsel, the Vero Beach
Museum of Art, the Riverside Children' s Theater and many more. Successful programs include :
Upward Bound, the Freedom School , the Cultural Camp, the After School Program, the
Preschool Early Literacy Program and much more.
The GYAC received the 2005 Outstanding Florida Minority Education Community Organization
Award. This was presented by Governor Jeb Bush and Education Commissioner, John Winn on
behalf of the Florida African-American Education Alliance. The GYAC has very talented and
dedicated staff and utilizes the expertise of its many partner organizations to offer quality
programs .
The population served by the GYAC includes : 89% African American. 59% of which come
from a home with a single parent (50% just a mom). 50% male — 50% female. 64% of children
served by GYAC reside in the Gifford area of Indian River County. 82% qualify for free or
reduced lunch (denotes living below the poverty level).
The number of children served daily grew from 175 to over 400 in 2005 .
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ORGANIZATION : GIFFORD YOUTH ACTIVITY CENTER
PROGRAM: SUMMER CULTURAL CAMP
FUNDER: 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.
What: Limited number of affordable programs available to working parents for summer
childcare. Who : Children with risk factors such as qualifying for the free or reduced lunch
program, living in single parent homes, alcohol tobacco or drug use, symptoms of depression,
displaying anti-social behavior or dropping out of school. Many families have single parents or
both parents working full time. Many parents find themselves stretched to the limit just trying to
provide basic needs . Where: The numbers of school aged children living in Indian River
County are located in the western, central and southern ends of the county. The children with the
greatest socioeconomic need are centrally located in the county. Summer programs offered for
children are limited. The Summer Cultural Camp offers productive, supervised activities that
give children tools for living. The Summer Cultural Camp is held at the Vero Beach Museum of
Art and the Riverside Children Theatre, which addresses the need for a central location. For
those in the Gifford area and needing transportation, GYAC will provide it daily to camp
participants . Data : Figures form the Florida Department of Education indicates a steady increase
in students in Indian River County eligible for the free or reduced lunch program. In 2000-2001 ,
the percentage was 39% and for 2001 -2002, the figure rose to 46%, a 7% increase in just one
year. This translates into 6,856 of the county' s 14,904 students being eligible for the free or
reduced lunch program. Data from the needs assessment conducted in 2002 by the Children' s
Services Advisory Committee indicated that the percent growth in impoverished families with
children in Indian River County had a 46% rise from 1990-2002. Evident in the report was a
need for mental wellness for children in our county. Prevention of mental distress and illness
was the recommended outcome. The Summer Cultural Camp program gives each child the
opportunity to identify a creative act that requires discipline and perseverance in mastering the
craft, which gives the child a healthy outlet for expression, increases his or her feelings of self
worth and gives the child constructive ways to spend spare time in healthy recreation. All of
these skills assist in the prevention of mental distress and illness.
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 Riverside Children' s Theatre and the Vero Beach Museum of Art have programs, but they
are not financially available for low income parents . This Summer Cultural Camp gives children
what could be the only opportunity they may have to be exposed to professionally instructed
visual and dramatic arts instruction at the GYAC . Boys & Girls Clubs and Daisy Bridgewater
Hope Center will be operational at this time for day care needs.
b) The Feed the Lambs operated by John May is a recreational and literacy based summer camp;
The GYAC ' s Haven Camp and Freedom School are an education/literacy based summer
programs . Only the Riverside Children' s Theatre and the Vero Beach Museum of Art offers
these art programs. This grant enables those in financial need to participate in these excellent
and enriching opportunities .
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ORGANIZATION: GIFFORD YOUTH ACTIVITY CENTER
PROGRAM : SUMMER CULTURAL CAMP
FUNDER: CHILDREN' S SERVICES ADVISORY COMMITTEE
C. PROGRAM DESCRIPTION (Entire Section C, 1 — 6, not to exceed two pages)
1 . List priority needs area addressed.
Focus Area I . Mental Wellness Issues in Children ages 7- 18 . This program improves the
capacity of children in Indian River County to succeed to adulthood in a safe, healthy, and
productive manner by meeting the following objectives : Promotes enhanced emotional and
social skills; Provides early intervention screening for children; Promotes life skills training and
effective use of emotional and social skills ; Promotes independent living skills; Promotes
accessible locations for healthy, productive activities.
Focus Area IL Childcare Access. This program supports caregivers, a child' s most important
resource, to be and do what is needed to shepherd children to adulthood in a safe, healthy, and
productive manner by meeting several stated objectives. This program increases the availability of
affordable quality summer programs to those who would not otherwise have the opportunity to
experience these cultural and ethnic activities .
2. Briefly describe program activities including location of services. The main activities of
this program are chosen to provide children and teens with creative tools to help them
succeed to adulthood in a safe, healthy and productive manner. Community artists teach the
classes in visual, dramatic arts. Classes are held in the art studios and the foundry at the Vero
Beach Museum of Art and also are held in the learning lab and the stage area at the Riverside
Children' s Theatre.
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. Several studies cite the use of the, arts as a prevention tool and for
positive development of children. A recent report issued to the Florida Senate from the
Committee on Criminal Justice in December 2002 , entitled "Review Effectiveness of
Juvenile Programs that use a Visual and Performing Arts-Based Intervention Approach"
summarized numerous studies that illustrate the positive impact these types of arts programs,
especially ones containing mentorship opportunities and relationships to the community,
influence at-risk children toward positive goals and behaviors. (The Arts and Prosocial
Impact Study, Rand, 1999 .) Students who have been consistently involved in music and
theatre exhibit higher levels of success in math and reading. (Secretary 's Commission on
Achieving Necessary Skills, U. S . Department of Labor, 1991 ) . A lengthy national project that
studied children from low income backgrounds found that those exposed to arts learning
were more likely to be class officers, involved with math and science fairs and to be
recognized with a writing award (Community Counts: How Youth Organizations Matter for
Youth Development), Shirley Brice Health, Milbrey W. McLaughlin, 2000. Exposure to arts
impacts the developmental growth of children and helps to equalize the learning curve that
cuts across diverse socio-economic backgrounds (UCLA Imagination Project, Americans for
the Arts, 1998). By providing arts opportunities and 9hoices at a young age, children become
motivated and engaged in this healthy outlet for expression.
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ORGANIZATION : GIFFORD YOUTH ACTIVITY CENTER
PROGRAM: SUMMER CULTURAL CAMP
FUNDER: CHILDREN 'S SERVICES ADVISORY COMMITTEE
4. List staffing needed for your program, including required experience and estimated
hours per week in program for each staff member and/or volunteers (this section
should conform with the information in the Position Listing on the Budget Narrative
Worksheet).
Professional Staff:
A. Art Instruction : Reports to the Creative Leaders and the Camp Director. Develops and
executes lessons plans in either visual, musical or performing arts . Required : Experience
in teaching arts to children, experience with either visual, musical or performing arts.
Contractual cost for instruction — 40 hours per week =$ 19,000. The Riverside Children ' s
Theatre will offer Theatre Arts Workshop and Performing Arts Day Camp. The Vero
Beach Museum of Arts will offer Clayworks, Fabric Fun, Inspiring Artists, Global Art,
Sculptural Forms, Wonderful World of Animals, Mixed Media, Create and Publish Your
Own Book, Ancient Egypt, Fabric and Batik, Garden Delights, Art of the East, Paper
Arts, Studio One Activity, Expressions, Scrapbooking, and Tie-Dye .
B . Dramatic Arts Instructors : Performing Arts Day Camp (ages 5 -7), five — 1 week
sessions ; Theatre Arts Workshop (ages 8 - 12), three — 1 week sessions; Riverside Rascals
Review (8 - 12), one — 2 week sessions; Video Camp (ages 8 - 12), one — 2 week session.
Required: Bachelor' s Degree in Dramatic Arts . Contractual Instruction = $ 11 ,000.
5. How will the target population be made aware of the program?
Students that have previously participated in the program receive notification by mail. Flyers are
distributed to Boys & Girls Clubs and Dasie BridgewaterHopeCenter. Spaces are reserved for
the collaborative partners. This includes, the Homeless Assistance Center, United for Children :
Foster Care Children, Youth Guidance, Hiz Kidz, Gifford Youth Activities Center and the
Truancy Prevention Program. Churches and other community organizations receive information
by mail. A public notice is published in the newspaper and the county recreation department
publishes the information in their summer brochure. Openings usually fill up quickly with this
outreach but word of mouth also brings more families to inquire .
6. How will the program be accessible to target population (i.e., location, transportation,
hours of operation)?
Parents/Guardians will be responsible for bringing their children either to the Vero Beach
Museum of Art or the Riverside Children' s Theatre. The GYAC is centrally located in the
county. If parents have transportation issues, the GYAC will transport their children from the
GYAC to and from the Vero Beach Museum of Art and the Riverside Children' s Theatre . Hours
of operation for the Summer Cultural Camp are Sam to 4pm, Monday through Friday.
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ORGANIZATION : GIFFORD YOUTH ACTIVITY CENTER
PROGRAM: SUMMER CULTURAL CAMP
FUNDER: CHILDREN'S SERVICES ADVISORY COMMITTEE
D. MEASURABLE OUTCOMES (Entire Section D not to exceed two pages)
OUTCOMES ACTIVITIES
Add all of the elements or the Measurable Outcome(s) Add the tasks to accomplish the Outcome(s)
1 . Provide an increase in affordable arts and 1 . 1 : Each child previously enrolled in the
cultural programs for children ages 7- 12 Summer Cultural camp will receive
enrolled in the free/reduced lunch program by information in the form of a flyer about the
providing one and two-week no-cost arts program.
programs.
1 .2 : All children and parents at the GYAC
after-school program will be provided Summer
Cultural Camp program specifics and
registration information.
2 . Increase appreciation of their own artistic 2 . 1 : Each camper will be given a pre-test on
ability by children ages 7- 12 as shown by an the first day of the program.
increase in positive self-reports after the
cultural camp experience as measured by a pre- 2.2 : Each camper will be given a post-test on
test at the start of the program, compared to the the last day of the program.
self-report on a post-test at the end of the
program . 2 . 3 : Results from the pre-test & post-test will
be presented in the final report.
3 . Increase the number of positive and trusting 3 . 1 : Professional Art Teachers, in a variety of
young adult and adult role models for children disciplines, will be recruited to staff the
ages 7- 12 in the free/reduced lunch program as summer cultural camp.
shown by self-reports after the cultural camp
experience as measured by a pre-test at the 3 .2 : Experienced Supervisors will be recruited
start of the program, compared to the self- to staff the summer cultural camp.
report on a post-test at the end of the program.
8
ORGANIZATION : GIFFORD YOUTH ACTIVITY CENTER
PROGRAM: SUMMER CULTURAL CAMP
FUNDER: CHILDREN' S SERVICES ADVISORY COMMITTEE
OUTCOMES ACTIVITIES
Add all of the elements for your Measurable Outcome(s) Add the tasks to accomplish the Outcome(s)
9
ORGANIZATION: GIFFORD YOUTH ACTIVITY CENTER
PROGRAM: SUMMER CULTURAL CAMP
FUNDER: CHILDREN 'S SERVICES ADVISORY COMMITTEE
E. COLLABORATION (Entire Section E not to exceed one page)
1 . List your program ' s collaborative partners and the resources 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
Cultural Council of Indian River Provide database of previous campers, provide database
County of previous staff, identify appropriate arts disciplines,
identify appropriate arts teachers.
Youth Guidance Referrals of teen volunteers, provides expertise and
consulting on teen training and volunteering issues.
Riverside Children' s Theatre Provide instruction staff, materials and teaching space
for programs.
Vero Beach Museum of Art Provide instruction staff, materials and teaching space
for programs.
10
ORGANIZATION : GIFFORD YOUTH ACTIVITY CENTER /
PROGRAM: SUMMER CULTURAL CAMP
FUNDER: CHILDREN'S SERVICES ADVISORY COMMITTEE
F. PROGRAM EVALUATION (Entire Section F not to exceed two pages)
1 . DEMOGRAPHICS : What information (data elements) will you need to collect in order
to accurately describe your target population including demographics (age, gender, and
ethnic background) required by the funder in Section H? What are the pieces of
information that qualify them for your target population? How do you document their
need for services or their "unacceptable condition requiring change" from Section BI ?
Necessary data will be collected from registration forms with a notation that the information
will be used for grant reporting purposes only. Children that are participating in the free or
reduced lunch program, have an additional risk factor as identified by the student support
specialist or teacher at their school . The presence of risk factors will be documented and shared
with staff, as deemed appropriate by the Program Coordinator. Indication from a teacher that
there is a strong interest in art also qualifies students to attend this camp.
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?
Registration for use by instructors, teachers and support specialists .
Database of participating students, including demographic information and indicated risk
factors.
Pre-test & Post-test
Identification of children with risk factors
Notify parents/guardians of children with risk factors to appropriate referral sources
Comparison of Pre-test & post test results.
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?
The most important information gathered would be the presence of risk factors indicted by the
referring entity or by instructors during the course of the program or at the end of the program.
Parents and guardians will be involved in addressing these risk factors. A final report, including
all test results, will be shared with the funder. All final reports are also on file at the GYAC
office.
11
ORGANIZATION : GIFFORD YOUTH ACTIVITY CENTER
PROGRAM : SUMMER CULTURAL CAMP
FUNDER: CHILDREN'S SERVICES ADVISORY COMMITTEE
G. TIMETABLE (Section G not to exceed one page)
1 . List the major action steps, activities, or cycles of events that will occur within the
program year. New programs should include any start-up planning that may occur
outside the funding year. In completing the timetable, review information detailed in
prior sections.
Month/Period Activities
February — April 2006 • Work with Vero Beach Museum of Art and Riverside Theatre
to plan program.
Contact all previous campers, staff, schools and collaborative
partners.
Send out informational flyer in the first week of May
• Assemble referrals from area schools, returning campers and
collaborative partners.
• Create updated database
May — June 2006 • Register program participants
June 2006 • Finalize classes
August 2006 • Summer Cultural Camp is conducted throughout the summer
Conduct pre-test & post-test
Identify children with risk factors
Notify parents/guardians of children identified with risk factors
to appropriate referral sources.
September 2006 • Office Wrap-up from program
Prepare final report
12
ORGANIZATION: GIFFORD YOUTH ACTIVITY CENTER
PROGRAM: SUMMER CULTURAL CAMP
FUNDER: CHILDREN'S SERVICES ADVISORY COMMITTEE
H. PROJECTIONS FOR UNDUPLICATED CLIENTS
Number of Unduplicated Clients by Location
Last Fiscal Year Current Fiscal Year Next Fiscal Year
Location Actual 2004/2005 Budget 2005/06 Projections2006/07
Unduplicated Clients Unduplicated Clients Unduplicated Clients
N. Indian River County 75 95 95
S. Indian River County 75 90 90
Indian River Co. Total 150 185 185
Greater Stuart - -
Hobe Sound -
hAiantown - -
Jensen Beach - -
Palm City - -
Martin County Total -
Fort Pierce - -
Port Saint Lucie - - -
St. Lucie Co. Total -
Other Locations - - -
TOTAL SERVED 1501 185 185
Number of Unduplicated Clients by Age
Last Fiscal Year Current Fiscal Year Next Fiscal Year
Location Actual 2004/2005 Budget 2005/06 Projections 2006/07
Individuals Group Individuals Group Individuals Group
0 to 4 - (Pre-school) - - - - - -
5 to 10 - (Elementary) 75 - 90 - 90 -
11 to 14 - (Middle) 65 - 80 - 80 -
15 to 18 - (High School) 10 - 15 - 15 -
Total Children 150 185 185
19 to 59 - (Adults) - - - - - -
60 + (Seniors) - - - -
Total AduAa -
TOTAL SERVED 150 185 - 185 -
13
Edit this Header. Type the organization and program name and the funder for whom it is being completed. The page d is already set at the bottom right
of every page.
I. BUDGET FORMS - To open the Budget Forms, please double-click on the icon below.
" Core Budget Forms "
14
1
Name: ' Age:
GYAC/CCIRC
Summer Cultural Camp
Pre - Test for Students
....... ......... . _ ....... ... ...... ......... ...... _..
Artistic means many creative things like:
painting drawing dancing playing or listening to music,
being in a play, writing a poem, singing or sculpting with clay.
Maybe you can think of more!
What are your Do you like to
favorite artistic share your
things to do? artwork to your
friends?
Do you like to
share your Do you like to talk
artwork with your with your
family? teachers about
your artwork?
Do you know anybody
else here? If yes, who are
they?
Name: ' Age:
GYAC/CCIRC
Summer Cultural Camp
Post - Test for Students
_................. ......
Artistic means many creative things like:
painting, drawing, dancing playing or listening to music,
being in a play, writing a poem, Singing or sculpting with clay.
Maybe you can think of more!
__ ....... .... ...... ......._....... ......................._.. .................. ..................._._.................... ................_.. .........-.........---.__....._..._...._......
..............._................_............................._.._........._.__.._.._.._._..__._ ..
Do you like to
What are your share your
favorite artistic artwork to your
things to do? friends?
Do you like to talk
Do you like to with your
share your teachers about
artwork with your your artwork?
family?
Have you made
any new friends? If
yes, who are they?
r
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 's p�bmitted wtt1 RFP No. 2006061 for
Ce..,S �' i U e, �W ll✓ �(( 1
- - U
2 . This sworn statement is submitted by: � � f- 0 vii Yom.,
! (Name of entity submitting Statement)
\i
whose business address is :
t� tlG �� C �C `D�/ /and
(if applicable)
its Federal Employer Identification Number FEIN is
y ( FEIN ) �( If the the entity has no FEIN , include the Social Security Number of the individual signing
this sworn statement
)
3 . My name is 1 A GAaL
(Please print name of individual signing)
and my relationship to the entity named above is
4 . 1 understand that an "affiliate" as defined in Section 105. 08, Indian River County
Code , means :
The term "affiliate" includes those officers, directors, executives, partners , shareholders,
employees , members , and agents who are active in the management of the entity.
5. 1 understand that the relationship with a County Commissioner or County employee
that must be disclosed as follows :
Father, mother, son , daughter, brother, sister, uncle, aunt, first cousin ,
nephew, niece , husband , wife, father-in-law, mother-in-law, daughter-
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
{ { / (signature)
(date)
STATE OF OY , 60.,
COUNTY OF CQy -� JQ
T e foregoing instrument was acknowledged before me this Q3� day of
20069 by M% C.. ct F ub le y , who is -personally rsonally known tome
or wh as produced as identification .
NOTARY PUBLIC ' 1—
SIGN : L -- of Tr
PRINT: Xt t> G D% i�)crnne
State of Florida at Large
My Commission Expires:
(Seal)
Nolary �tic - flaN of ibMelo
pYrhty�7.2007
C.OnM�Y1b� #� DD194076
Bwdwbv �eaw my Wn
NOT FOR PROFIT AGENCY CERTIFICATION
The County of Indian River requires, as a matter of policy, that any Consultant or firm
receiving a contract or award resulting from the Request for Qualifications issued by the
County of Indian River, Florida, shall make certification as below. Receipt of such
certification , under oath , shall be a prerequisite to the award of contract and payment
thereof.
I (we) hereby certify that if the contract is awarded to me , our firm , partnership , or
corporation , that no members of the elected governing body of Indian River County, nor
any professional management, administrative official or employee of the County, nor
members of his or her immediate family, including spouse, parents , or children , nor any
person representing or purporting to represent any member or members of the elected
governing body or other official , has solicited , has received or has been promised ,
directly or indirectly, any financial benefit, including but not limited to a fee, commission ,
finder's fee, political contribution , goods or services in return for favorable review of any
Proposal submitted in response to the Request for Qualifications or in return for
execution of a contract for performance or provision of services for which Proposals are
herein sought.
The undersigned certifies that he/she is a principal or officer of the firm applying for
consideration and is authorized to make the above acknowledgments and certifications
for and on behalf of the applicant.
The undersigned certifies that the Applicant has not been convicted of a public entity
crime within the past 36 months, as set forth in Section 287. 133 , Florida Statutes.
Failure to sign this form will result in disqualification. _
Handwritten Signature of Authorized Principal(s): DATE: c1
t
NAME : \ l - 0
TITLE: -
NAME OF FIRM/PARTNERSHIP/CORPORATION : t ' LO - V6 . A - .
FOR AND ON BEHALF OF THE APPLICANT:
Sworn to and subscribed to
me, a Notary Public, this
c33rd day of 12006 . BY:
(SEAL) (TYPE NAME & TITLE)
hbk • NO& of HoAda
WRoled
17,20D7
n*WOn I DD194076
By Nolio K0 Nofo yAW, .
XI
GVAC - Cultural Camp Program
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 : Gifford Youth Activity Center - Cultural Camp
FUNDER : Children 's Services of indian River County
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . _ . . . . . . . . . . . . . . . . . . . . . . . _ . . . . . . . . . . . . . . .
. . . . . . . .
1
CAUTION : Do not enter any figures where a cell is colored in dark blue - Formulas and/or links are m lace. Gra areas should I
: be used for calculations and to write information only.
r
ON"YAXEAa FON Proposed Total Pro ramrFunderSpeciricREVENUES AWN� OSEONLY p0 99 Y
(SNOW DETAILS Budget Budget Budget
cucuunoxsl
1 Children's Services Council-St. Lucie i
2 Children's Services Council-Martin
3 Advisory Committee-Indian River 30,000.00 30,000.00 153,673.96
4 United Way-St. Lucie County
5 United Way-Martin County
6 United Way-Indian River County 0.00 0.00 90,000.00
7 Department of Children & Families
8 County Funds 0.00 0.00 163,000.00
9 Contributions-Cash 0.00 0.00 228,623.00
10 Program Fees 0.00 0.00 73,500.00
11 Fund Raising Events-Net 0.00 0.00 60,000.00
12 Sales to Public - Net
13 Membership Dues 0.00 0.00 6,300.00
14 Investment Income
15 Miscellaneous 0.00 0.00 96,636.04
16 Legacies & Bequests
17 Funds from Other Sources
18 Reserve Funds Used for Operating 10,669.50 0 .00 207,000.00
19 In-Kind Donations (Not included in total) 0.00 0.00 30,000.00
20 TOTAL REVENUES
(doesn't include line 19) $40,669.50 $30,000.00 $1 ,078,733.00
A B C D
EXPENDITURES GRAYANEAS FON Proposed Total Program Funder Speck Total Agency
AGENCY UBE ONLY
Isxow cALcuunons Budget Budget Budget
21 Salaries - (must complete chart on next page) 6,743.501 0.00 567,650.00
Salary
22 FICA - Total salaries x 0.0765 I7.65% 0. DO
e remen - Annual pension lot qua le17-
23 staff 0.00
Life/Health - e Ica enta ort-term
24 Disab. 0.00
Workers Compensation - # employees x
25 rate 0.00
monde Unemployment - # proiece
26 employees x $7,000 x UCT-6 rate 0.00
A °
SALARIES B
Gross Annual Portion of Salary oYo n Proposed C of Gross Annual
POSITION LISTING salary Prograrf Funder Specific Budget Requested(CIA)
SGA)
Position Title / Total Hrs/wk (Agency)
Example: Executive Director/40 hm 70,000.001 10,000.00 5,000.00 7.14%
5!2312006 a-1
GYAC - Cultural Camp Program
Executive Director (1 )/40 hrs 66,950. 00 669.50 0.00 0.00°
Admin . Of Development & Mktg ( 1 )/40 hrs 51 ,904. 00 519 ,04 0.00 0.00%
Education Coordinator (1 )/40 hrs 30,000.00 1 ,500.00 0.00 0.00°
Administrative Assistant (1 )/40 hrs 30,000.00 300.00 0.00 0 .00°
Receptionist ( 1 )140 hrs 23,456.00 425.00 0.00 0.00°
Custodian ( 1 )/40 hrs 26,020.00 0 .00 0.00 0.00
Mentor Coordinator (1 )/25 hrs 15,000.00 0.00 0.00 0.00°
Camp CounselorsfTeachers ( 15)/40 hrs 76,020.00 760.00 0.00 0.00
After School Teachers (10)/15 his 76,020.00 0.00 0.00 0.00%
Recreation Leaders (2)/20 hrs 18,804.00 188.00 0.00 0.00
Asst. Academic Coordinator ( 1 )/20 hrs 10, 136.00 101 .00 0.00 0.00°
0%
Librarian (1 )/40 hrs 32,500.00 0.00 0.00 0.00
Librarian (1 )120 hrs 12,500.00 0.00 0.00 0.000
Mental Health Counselor ( 1 )/40 hrs 40,000.00 0.00 0.00 0.00
Family Counselor ( 1 )/8 hrs 8,640.00 0.00 0.00 0.00°
Student Dean (1 )140 hrs 33,200.00 0.00 0.00 0.0
Bus Driver ( 1 )/30 hrs (Summer) 4,500. 00 1 ,800.00 0.00 0.000
Bus Driver ( 1 )/20 hrs (School year) 12,000. 00 0.00 - 0.00 0.00°/
Remaining positions throughout the agency
Total Salaries $567,650.00 $5,743. 50 $0.00 0.00%
FRINGE BENEFITS DETAIL A
(Funder Specific Budget Funder B c D E F c
Pension Worker's Unemployme Total Fringes Funder
Column C only, from line 22 to 27) Speck FICA 7.65% (A x Y) Health Ins. Compens. nt Compens. Specific
Position Title / Total Hrs/wk Budget
Example: Case Manager/40 hrs 5,000.00 382.50 200.00 500.00 300.00 200.00 1,582.50
Executive Director ( 1 )140 hrs 0.00 0.00 O.D
Admin , Of Development & Mktg ( 1 )/40 hrs 0.00 0.00 O.0
Education Coordinator ( 1 )/40 hrs 0.00 0.00 0.0
Administrative Assistant ( 1 )/40 hrs 0.00 0.00 0.0
Receptionist (1 )/40 hrs 0.00 0.00 0.0
Custodian (1 )140 hrs 0.00 0.00 0.0
Mentor Coordinator ( 1 )/25 hrs 0.00 0.00 0.0
Camp Counselors/Teachers ( 15)140 hrs 0.00 0.00 0.0
After School Teachers (10)/15 hrs 0.00 0.00 0.0
Recreation Leaders (2)120 hrs 0.00 0 .00 0.0
Asst. Academic Coordinator ( 1 )/20 hrs 0.00 0.00 0.0
Librarian ( 1 )/40 hrs 0.00 0.00 0.0
Librarian (1 )120 hrs 0.00 0 .00 0.0
Mental Health Counselor ( 1 )140 hrs 0.00 0 .00 0.0
Family Counselor ( 1 )/8 hrs 0.00 0.00 0.0
Student Dean ( 1 )/40 hrs 0.00 0.00 0.0
Bus Driver ( 1 )/30 hrs (Summer) 0.00 0.00 0.0
0.00 0.00 0.0
Total Funder Request Fringe Benefits $0.00 $0.00 $0.00 $0.00 $0.00 $O.DO $0.0
A B C D
EXPENDITURES GRAY PREAa FOR Proposed Total Program Funder Specific Total Agency
xoHMoONLYro Budget Budget Budget
27 Travel-Daily 1 ,600.00 0.00 23,738. 00
# of Staff x average # of miles/wk x 50 wks x
$ = Estimated Daily Travel/Mileage Reimb.
28 Travel/ConferenceslTraining 0.00 0.00 22,430.00
• National Conference (cost per staff)
• Training/Seminar (cost per staff)
• Other Trainings (cost of travel , lodging ,
registration , food)
29 Office Supplies 50.001 0.00 29,815 .00
5123!2006 8-1
GVAC - Cultural Camp Program
• Office supplies (monthly average x 12
months = estimated cost of office supplies
based on present history.
30 Telephone 175.00 0.00 6,500.00
• # Phone lines x average cost per month x
12 months = local phone cost
• Average long distance calls x 12 months =
Estimated cost of long distance
31 Postage/Shipping 250.00 0.00 2,850.00
• Quarterly Mailing of Newsletter
• Special events , etc.
• Bulk mailings - appeals
32 Utilities 305.00 0.00 28,000.00
• Electricity ($ x 12 months)
• Water/Sewer ($ x 12 months)
• Garbage ($ x 12 months)
33 Occupancy (Building & Grounds) 6,000.00
• Mortgage/Rent ($ x 12 months)
• Janitorial ($ x 12 months)
• Grounds Maint. ($ x 12 months)
• Real Estate Taxes
34 Printing & Publications 250.00 0.00 7,500.00
• Quarterly Newsletter ($ x 4)
• Letterheads, Envelopes, etc.
• Fundraising materials
• Other
35 Subscription/Dues/Memberships 0.00 0.00 750.00
7M-embership to National Organization
• Dues
• Subscriptions to Newspapers/magazines,
etc.
36 Insurance 495.00 0.00 48,500.00
• Directors/Officers Liab.
• Commercial/General Insurance
• Bond Ins .
• Auto Insurance
37 Equipment: Rental & Maintenance 1 ,700.00
• Copier lease ($ x 12 months)
• Meter lease ($ x 12 months)
• Copier Maintenance ($ x 12 months)
• Computer Maintenance ( $ x 12 months)
• Other
38 Advertising 2 ,500.00
• Newspaper ads
• Fundraising ads/promotions
• Other (vacancies)
39 Equipment Purchases:Capital Expense 11 ,500.00
• Computer/monitor (# x $)
• Laser Printer
40 Professional Fees (Legal, Consulting) 32 ,500.00
Legal advice ( estimated #hrs x $)
Consultant fees
• Other
41 Books/Educational Materials 1 0.00 6,250.00
• Books/videos
• Materials ($ x staff)
42 Food & Nutrition 0.00 0.00 15,560.00
• Meals ( # meals x clients x 5days x 50 wks)
• Snacks
43 Administrative Costs 1 ,751 .00 0.00 83,000.00
Admin. Cost (a/o of total budget)
44 Audit Expense 50.00 0.00 5,000 .00
u23noos Bn
GVAC - Cultural Camp Program
• Independent Audit Review
45 Specific Assistance to Individuals 4,000.00
• Medical assistance
• Meals/Food
• Rent Assistance
• Other
46 Other/Miscellaneous 0.00 0.00 1 ,920.00
• Background check/drug test
• Other
47 Other/Contract 30,000.00 30,000.001 171 ,070.00
• Sub-contract $19,000 to VBMA & $11 ,000 to
RCT
48 TOTAL EXPENSES $40,669.50 $30.000.00 $1 ,078 ,733.00
s�za�zoas B'�
GYAC . CWu Cmp Rrynm
UNIFORM GRANT APPLICATION
TOTAL AGENCY BUDGET
AGENCYIPROGRAM NAME: GYAC - Cultural Cam
FY 04/05 FY 05106 FY 06/07 % INCREASE
FYE FYE FYE CURRENT VS.
NEXT FY BUDGET
A B C D
ACTUAL TOTAL PROPOSED Icai. c W. sycoi. e
REVENUES BUDGETED BUDGETED
I Children's Services CouncilSt. Lucie 0.DO #DIV/01
2 Children's Services Council-Martin 0.00 #DIV/01
3 Advisory Committee-Indian River 30000.00 92400.00 153673.96 66.31 %
4 United Way-St. Lucie Countv 0.00 #DIV/01
5 United Way-Martin County 0.00 #DIVIO!
6 United Way-Indian River County 38 250.00 90 ODD 00 135.290/6
7 Department of Children & Families 0.00 #DIV/0!
e CountyFunds 122 443.00 182 939.00 163 000.00 -10.90%
9 Contributions-Cash 136750.00 526083.00 226623.00 56.54A
10 Program Fees 7350000 #DIV/0!
11 Fund Raising Events-Net 7000.00 4528.00 60000.00 1225.09%
12 Sales to Public-Net 0.00 #DIV/0!
13 Membership Dues 7,500.00 38 645.00 6300.00 53.70%
14 Investment Income 100 000.00 930100 0.00 -100.00%
15 Miscellaneous 22816.00 96,636.04 323.55%
16 Legacies & Bequests 0.00 #DIV/01
17 Funds from Other Sources 199 500.00 30,793.00 0.00 -100.00%
18 Reserve Funds Used for Operating 207 000.00 #DIV/O!
1s In-Kind Donations (Not ncladed In too, ) 30000.00 #DIV/0!
20 TOTAL 603 193.00 945 755.00 1 ,078,733.00 14.06%
EXPENDITURES
21 Salaries 294226.00 472166.00 567650.00 20.23%
22 FICA 22 919.00 36 120.00 0.00 -100.00%
23 Retirement 8988.00 12842.00 0.00 -100.000/4
24 Life/Health 28184.00 34877.00 0.00 -100.00%
25 Workers Compensation 12 853.00 19 574.00 0.00 .100.00%
26 Florida Unemployment 7,944.00 12 748.00 0.00 -100.00%
27 Travel-Daily 11358.00 13561 .00 23738.00 75.05%
28 Travel/ConferencesrTrainin 6148.00 22430.00 264.83%
29 Office Supplies 18 002.00 18 658.00 29 815.00 59.80%
3o Telephone 18002.00 8430.00 6500.00 -22.89%
31 Postage/Shipping 3 501 .00 372300 2 850.00 -23.45%
32 Utilities 37 900.00 29 540.00 28 000.00 -5.21 %
33 Occupancy (Building & Grounds 27 900.00 6,000.00 6 000.00 0.00%
34 Printina & Publications 4,978.00 7,500.00 50.66%
35 Subscri tion/DueslMembershi s 35654.00 3460.00 750.00 -78.32%
36 Insurance 48771 .00 48500.00 -0.56%
37 E ui ment:Rental & Maintenance 29 461 .00 1 ,700.01) -94.23%
38 Advertising 224000 250000 11 .61%
39 Equipment Purchases:Ca ital Expense 11 500.00 #DIV/Ol
40 Professional Fees (Legal, Consulting) 10 306.00 32 500.00 215.35%
41 Books/Educational Materials 5,628.00 6,250.00 11 .05%
42 Food & Nutrition 9.452.00 15 560.00 64.62%
43 Administrative Costs 61 087.00 8100000 83,000.00 2.47%
44 Audit Expense 6,600.00 S,000,00 5,000.00 0.00%
45 Specific Assistance to Individuals 40000
. 0 #DIVID!
46 Other/Miscellaneous 8,815.00 1 920.00 #DIV/0!
47 Other/Contract 71 028.00 171 070.00 140.85%
4a TOTAL 603 833.00 945 701 .00 1 ,078,733.00 14.07%
-100.00%
45 REVENUES OVER! UNDER EXPENDITURES -640.00 54.00 0.00
�� s:
GYACC Umc Pmp
UNIFORM GRANT APPLICATION
TOTAL PROGRAM BUDGET
AGENCY/PROGRAM NAME: GYAC - Cultural Cam
FY 0005 FY 05/06 F"W07 % CREASEFYE FYE FYERENT VS.FY BUDGETA B DACTUAL TOTAL PRcoi. eycoi. BREVENUES
BUDGETED BU1 Children's Services Councils[. Lucie DIVIO!Children's Services Council-Martin DIV/0!3 Adviso
Committee-Indian River 288DO.00 4.17%
4 United Way-St. Lucie County 0.00 #DIV/O!
6 United Way-Martin County 0.00 #DIV/0!
6 United Way-Indian River County 0.00 DMO!
7 Department of Children & Families 0.00 #DMO!
8 County Funds 0.00 #DIV101
9 Contributions-Cash 0.00 #DMO!
io Program Fees 0.013 #DIV/O!
11 Fund Raising Events-Net 0.00 #DIV10!
12 Sales to Public-Net 0.00 #DIV/0!
13 Membership Dues 0.00 #DMO!
14 Investment l ncom0.00 #DIVID!
e
15 Miscellaneous 0.00 #DIV101
16 Legacies & Bequests 0.00 #DIV/0!
17 Funds from Other Sources 0.00 #DIVIO!
16 Reserve Funds Used for Operating 9,408.42 10,669.50 13.40%
19 In-Kind Donations !Not included in tomq 0.00 #DIV/O!
20 TOTAL 0.00 38 208.42 40 669.50 6.44%
EXPENDITURES
21Salaries 5171 .20 5743.50 11 .07%
22 FICA 395.60 0.00 -100.00%
z3 Retirement 77.56 0.00 -100.00%
24 Life/Health 84.12 0.00 -100.00%
25 Workers Compensation 214.09 0.00 .100.00%
26 Florida Unemployment 139.62 0.00 -100.000%
27 Travel-Dailv 481 .00 1 ,600.00 232.64%
28 Travel/Conferences/Training 0.00 0.00 #DIV701
z9 Office Supplies
48.33 50.00 3.46%
30 Telephone 175.00 175.00 0.00%
31 Postage/Shipaina 234.68 250.00 6.530/6
32 Utilities 291 .00 305.00 4.81%
33 occupancy (Building & Grounds 0.00 0.00 #DIV/0!
34 Printin & Publications 78.22 250.00 219.61%
35 Subscri tion/Dues/Membershi s 0.00 0.00 #DIVIO!
36 Insurance 445.00 495.00 11 .24%
37 E ui ment:Rental & Maintenance 0.00 0.00 #DIVIDI
38 Advertising0.00 0.00 #DIV1D1
39 Equipment Purchases:Ca ital Expense 0.00 0.00 #DIV/O!
aD Professional Fees (Legal, Consulting) 0.00 0.00 #DIV/0!
41 Books/Educational Materials 0.00 0.00 #DIV/0!
42 Food & Nutrition 0.00 0.00 #DIV/0!
43 Administrative Costs 1 ,523.00 1 ,751 .00 14.97%
4a Audit Expense 50.00 50.00 0.00%
45 Specific Assistance to Individuals 0.00 0.00 #DIV10!
46 Other/Miscellaneous 0.00 0.00 #DIV/01
47 Other/Contract 28 800.00 30,000.00 4.17%
as TOTAL 0.00 38 208.42 40 669.50 6.44%
49 REVENUES OVERT UNDER EXPENDITURES 0.001 0.00 0.00 #DIV/O!
44
saeme
GYAC CulNral Camp Pm9ram
UNIFORM GRANT APPLICATION
FUNDER SPECIFIC BUDGET
PROGRAM EXPENSES
AGENCY/PROGRAM NAME : GYAC - Cultural Camp
FUNDER : Children 's Services of IRC A B C
FY 06/07 FY 06107 % OF
TOTAL FUNDER TOTAL VS.
PROGRAM SPECIFIC FUNDER REQUEST
BUDGET BUDGET (col. B/col. A)
EXPENDITURES
21 Salaries 51743.50 0 .00 0 .00%
22 FICA 0.00 0 .00 #DIV/0!
23 Retirement 0.00 0 .00 #DIVIO!
24 Life/Health 0 .00 0.00 #DIVIO!
25 Workers Compensation 0 .00 0.00 #DIV/0 !
26 Florida Unemployment 0 .00 0.00 #DIV/0 !
27 Travel-Daily 11600 .00 0. 00 0.00%
26 Travel/Conferences/Training 0 .00 0.00 #DMO!
29 Office Supplies 50 .00 0.00 0 .00%
3o Telephone 175.00 0.00 0.00%
31 Posta e/S hipping 250 .00 0.00 0.00%
32 Utilities 305.00 0 .00 0. 00%
33 Occupancy ( Building & Grounds 0.00 0 .00 #DIV/01
34 Printing & Publications 250.00 0 .00 0.00%
35 Subscription/Dues/Memberships 0.00 0.00 #DIVIO!
361nsurance 495.00 0.00 0.00%
37 Equipment: Rental & Maintenance 0.00 0.00 #DIV101
36 Advertising 0.00 0.00 #DIVIO!
39 Equipment Purchases : Ca ital Expense 0.00 0.00 #DIV/0!
40 Professional Fees (Legal, Consulting) 0.00 0. 00 #DIVIO!
41 Books/Educational Materials 0.00 0.00 #DIV10 !
42 Food & Nutrition 0.00 0.00 #DIV/O !
43 Administrative Costs 1 ,751 .00 0 .00 0 .00%
44 Audit Expense 50.00 0 .00 0 .00%
45 Specific Assistance to Individuals 0.00 0 .00 #DIV101
46 Other/Miscellaneous 0.001 0 .001 #DIV101
47 Other/Contract - $ 19, 000 VBMA & $11 ,000 RCT 309000.00 30,000.00 100.00%
48 TOTAL $40 ,669.50 $309000.00 73. 77%
52M2 6<
GYAC -CugmtlCMPPmpram
UNIFORM GRANT APPLICATION
EXPLANATION FOR VARIANCES OF 15% OR MORE
TOTAL PROGRAM BUDGET
AGENCY/PROGRAM NAME: GYAC - Cultural Camp
FUNDER: Children's Services of Indian River County
UNE ITEM EXPIANATIONEOR VARIANCE
#DIV/O!
7DIV/01
#DN/0!
#DIVIO!
#DIV/0!
#DIV/0!
#DIV/0!
#D!V/01
#DIVIO!
#DIV/01
#DN10!
#DIV/0!
#DIVIO!
#DIVIO!
#DN101
#DN/O!
#DN/0!
Travel-Dail
#01VIV
#DIVIO!
Fn�flna & Publications
#DIVIO!
#DIV/0!
75100!
#DIVIO!
#DIVIO!
75I000
#DN/O!
#DIVIO!
#DIV/0!
5qm" BZ
cYAC . CUft nA Camp Program
UNIFORM GRANT APPLICATION
EXPLANATION FOR VARIANCES OF 15% OR MORE
FUNDER SPECIFIC BUDGET
AGENCY/PROGRAM NAME : GYAC - Cultural Camp
FUNDER: Children's Services of Indian River County
UNE /TEiN . EXPLANATION FOR VARIANCE -
#DIV101
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/01
#DIV/01
#DIV/0!
#DIV101.
#DIV101
#DIVI01
#DIV101.
#DIV/01
#DIV101
#DIVw!
#DIV/0!
#DIV101
Mher/Contract - 19 000 VBMA 8 11 000 RCTm. Changed from paid staff to Contracted services for instruction.
srz3aace a-s
SUPPORTING DOCUMENTS CHECKLIST
RFP 2006061
/ Cover Page
// Application
List of current officers and directors
Latest Financial Audit Report & Management Letter that conforms with the
AICPA Audit Guide
/Most recent IRS Form 990, including all schedules
✓ Most recent Internal Financial Statement (i . e. : Balance Sheet and Operating
Budget
y Staff Organizational Chart
Most Recent Annual Report (if available)
_L,�501 (C)(3) IRS Exemption Letter
/Articles of Incorporation
✓/Agency's Bylaws
c/�gency's written policy regarding Affirmative Action
!/ Nepotism Statement
t/Taxonomy Definition for each program.
XVI
GiffordTouthAaft ity Center
"Van X Wkhardson, 7fonorary Chairman/ Chairman, CJraceumd Fruit Company
1626 90'6 Avenue
Vero Beach, TFL 32966
567-1151
'(Dr: A. 4Wrrafd7fudson, Chairman Emeritusll?;tiredlndian WmerSchoof(DistnctAdministrator
4640 — M6° Av.;
Vero Beach, EL 32967
(Ph: 567-7290
Email jporte16 @ hotmadcom
°,yohn (Dean, Architect, Charnnan/(Director
2223 — 10s.Avenue
'hero Beach, TL., 32960
Tk 567-4907/TFaX 569-3939
E-maik 'deanarch eartfdmkcom
Ktherme 'Washmgton, SecretarylOvrctoreZExecumvOtnector, Indian fur County SchooCcDistrict
(Rstir4
4456 — 28a. Av.
Vero Beach, (FL 32967
41k- 562-8688.
Emaif
"^Tomas' 9Zene ' ftrez, Asst.Treasurer/(Director, eZTreasurer, Graceuwd Eruit Co.,
1626 — 90 Avenue
Vero Beach, EL 32966
q4v 567-1151 ° 'F'ax569-1749
Email trya{c@aoCcom
ErderaDonafdBrown; (Director, Locaf(Fastor, SeniorWmister, Telfsmere Church of God/Business-
Owner
446128 Court
Vero Beach, TL 32967
A- 567-9534
17
**Kpv: ttBrowning0wect0r, Indian w1perCounty SehooftDistrict
19267Ctghkrids Drive SW
Vero Beach, TL 32962
Ph: 564-3000 * Tax564-3049 rEmad dr6rownman@aofcom
Craig Caffatb Director, `Bice President, Dodger Organisation, Dodgertown
Dodger Town
TOBox 2887
Vero Beach, TL 32961
Ph: 5694900 * TFaz770-2424
Emad craitjc@&wrodwrs. cort
Thomas CjifTespie, Director; &tired CEO- LockfiartIron cZSteefCo.
4880 N Newport Isfand(Dr
Vero Beach, TL 32967
Ph: 569-7535.
Victor7fart, Sr, cDirector, President of the NAACP
PO Box5193
Vero Beach, TL 32961
Phr 5674406
4896 Ottesen
Wachovia Securities
3545 Ocean Orive 3rdffoor
Vero Beach, TL 32963
Phone: (772) 231-9200
Toff Tree: (800) 325-3256
fax- (772) 231-5938
Ph: 231-5351, (Oft.) 794-91461 (Aes)
Emai( robert. ottesen@wachoviasec.com
Dr: Eddie9fudson, cDirector, 4ttired,Administrator, Indian 9zverCounty SchoofDistrict
1296 SW19"16 ,9venue
Vero Beach, TL 32962
567-8525' Tax567-6591
Emai - ehudscnedd@ 6effsoutfii. ret
**Mr. ,doe Idfette, Jr., 4ZFtiraIWCS0, eZ Board Member, Business Owner
4730 — 58`6
. ,4tvnue
Vero Beach, TL., 32967
Ph.- 562-6656
18
W,Tz m .`Minns, Jr., Victor, Ousiness Owner
�FO Box381
Wa6asso, EPL 32970
589-4604
or. (DavidSuf hk= Disector, Provost, Indium ftw Community College
Indian 40v rCommunttyCollege
6155 College Lane
`hero Beach, TFL 32966
Pk- 226-2505, 1-866-866-4722. - Pa7c462-4615
Emad- &uUiw@ircc. ccfTus
**94s. Carolyn Oefer, Director
7farbor TFederaf
655 21" Street
Vero Beach, SIL. 32960
772-562-1666(Oj 772-562-1706, cZ 562-1565 (T4 473-8286 (Cel)
Phone #772-2994186
Fax # 772-562-1706
Ceff # 772473-8286
g41r. 91ferriR'Rug, Indian PjwrCounty Sc600(Board4stiree, Director
46851" Street
Nero Beach, Ef 32968
772-567-3892
4jgv. SyfmsterWclntosk (Director, Vnitedstates Post Office,
6485 — 86th. Lane
Nero Beach, TL., 32967
772-589-3882
Yfs. 7Tossie Jackson, Indian W;w Community College, tDurctor
3209 Virginia ft,
Pt. Pierce, EL., 34981
Phone: (772) 559-2313011-866-866-47221 (0) . 772462-7467
E-mad fjackFonG ircc.edu
94rs. Wary B. WcKinu y, MCSO W;tiree
5616 41". Street
Nero Beach, EPL., 32967
Pk- 562-3941
19
4r. Godfrey Gipson, IWM Oiuctp9 Vtired
41365;n' Ct.,
Vero Beach, EFL., 32967
Th. 562-4731
,rytrs. am" Chander
EF..xecutnw (Dir. IIZC Chamber of Commerce
1216 21n. St.,
Vero Beach, EFL., 32960
Tfi: 567-3491
9Kr. EPauf W Ingram
455 - 10's. �Pl, S. W,
Vero Beach, EFL 32962
Tk- 794-1502
'Deputy Teddy EFToyd, I9ZC Sheriffs Dept.
405541'x. Street
Vero Beach, EFL 32967
772-569-6700, 978-1838, tZ 299-3525.
%owardSutfiff
88910°A. EDrim
Vero Beach, AFL 32960
A- 770-1926
**Venotes ETecutive Boardmember
20
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 1st may be reimbursed with funds from the following
year. Additionally, if any funds are unexpended at the end of a fiscal year, these funds are not
carried over to the next year unless expressly authorized by the Board of Commissioners .
All requests for reimbursement at fiscal year 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
18402 51h Street
Vero Beach , Florida 32960-3365
Recipient: GYAC
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 -
ACORDTm CERTIFICATE OF LIABILITY INSURANCE DAT10105112250006S
0
10!
PRODUCER Phone: (T72OB SEZOF LO IDA, INC. - THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
HILB ROGAL 6 HOBBS OF FLORIDA, IN . - VERO BEACH ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
204514TH AVE. HOLDER THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
P O BOX 130 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW,
VERO BEACH FL 32961
INSURERS AFFORDING COVERAGE NAIC #
WSURED INSURERA: GRANITE STATE INS CO
GIFFORD YOUTH ACTIVITY CENTER INSURER B: Progressive Amerlcan Insuranca Co. 24252
RD AVE
VERO BEACH FL 32967 INSURER C: ZENITH INIS COMPANY
VERO
INSURER D: _
INSURER E:
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INOICATEO, NOTWITHSTANDING
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CWMS.
wsRlnO
RATION POUCYNUMBER POLICYEtFECInrE
LIR INSR OATC MWAD rare M
LIMITS
GE_NERALLABULITY 02-LX-0489330-01000 05115106 06/15107 EACH OCCURRENCE $ T , o00,00G
X COMMERCIAL GENERAL LIABILITY &A PREM E9TO REnTEO eI g 100,000
1- 7 CLAIMS MADE OCCUR MED. EXP tAm ono Parson) Is 5,000
B X BIIPD DEDUCTIBLE 81,000 PERSONAL B ADV INJURY S 1 ,000,000
OENERALAGGREGATE 8 3,000, 000
GEHL AGGREGATE LIMIT APPUES PER PRODUCTS-COMP/OPAG6 S 11000,000
e o _ —i PP.CL —. _ _
EI T I1
AUTOMCBILELMIMLITY 02628305-2 04=06 04123107 COMBINED SINGLE LIMIT
X ANY AUTO (EaaccJdant) 8 1 ,000,000
ALL OWNEDAUTO.S BODILY INJURY
SCHEOULEDAUTOS (Par P°rson) S
B X HIREOAUTOS _ ----
BODILY INJURY
X NON.OWNEDAUTOS (Par arddent) S
PROPERTY DAMAGE 8
PBrardde
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT =
ANY AUTO OTHERTHAN EAACC T
AUTO ONLY; AGG [
EXCESS/ UMBRELLA LABILITY EACH OCCURRENCE S
OCCUR 71 CWMS MADE AGGREGATE g
S
DEDUCTIBLE g
RETENTION -
8
WORKERS COMPENSATION ANDwe SAT"' OTHEREMPLOYERS' LABILITY 2068006301 01/04/06 01104!07 TORT uMITS
C AM' PROPNSTOANARTRERKlMUTIVE E.L EACH ACCIDENT S 1001
000
EMPLOYEE S
pGFlCE%MEMBER @ICA DEO] — "
E DISEASE-EA 100,000
ew' amcrmo uoao.
SPECNL PROVISIONS below EL DISEASE-POLICY LIMIT 8 500,000
OTHER:
DESCRIPTION OF OPERATION S/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS
INDIAN RIVER COUNTY IS NAMED AS AN ADDITIONAL INSURED AS THEIR INTEREST MAY APPEAR.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVORTO MXL10 DAYS
WRITTEN NOTIOE TO THE CERTIEICATE HOLDER NAMED TO THE LEFT, BUT FAILURE
TO DO SO SHALL,IMPOSE NO OBLIGATION-OR LIABILITY OF ANY KIND UPON THE INSURER,
INDIAN RIVER COUNTY ITS AGENTS OR REPRESENTATIVES.
1840 25TH STREET
VERO BEACH FL 32960 AUTHORIZED REPRESENTATIVE
Attention: _ - . ge . Thi
ACORD 25 (2001108) Certificate # 96907 C ACORD CORPORATION 1988