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Home My WebLink About2006-331R. INDIAN RIVER COUNTY GRANT CONTRACT This Grant Contract ("Contract") entered into effective this day of October 2006, by and between Indian River County, a political subdivision of the State of Florida; 1840 25`" Street, Vero Beach , Florida, 32960-3365; and Exchange Club Castle (Recipient), of: Exchange Club Castle P .O . Box 12908 Fort Pierce, Florida 34979 Safe Families 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 . - 1 - 4 . Grant Funds and Payment. The approved Grant for the Grant Period is: FORTY SEVEN THOUSAND, DOLLARS ($47,000). 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 - 2 - damage, including coverage for premisesloperations, 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, lasses, 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 . - 3 - IN WITNESS WHEREOF, County and Recipient have entered into this Contract on the date first above written . INDIAN RIVER C�OMT,T BQARD OF COMMISSIONERS By: Gary Whel' er': , Chairman BCC Approved' c .n ' � ' 0(0 Attest: J . K. Barton , Clerk By: Deputy Clerk n Approved : Joseph' A. Baird County Administrator Approved as to form and legal suffici y: B "� arian 12 . Fell , AssisCunty Attor ey RECIPIENT: Exchange Club Castle - 4 - EXHIBIT A (Copy of complete Request for Proposal ) EXHIBIT - A - • _ - Organization: Exchange Club CASTLE Program Name : Safe Families Funder: Children' s Services Advisory Committee RFP# 2006061 PROGRAM COVER PAGE Organization Name : Exchange Club CASTLE Executive Director: Theresa Garbarino-May E-mail : tgarbarino-may@exchangecastle. org or _ Address : PO Box 12908 Telephone : 772-465 -6011 Fort Pierce, FL 34979 Fax : 772-465-6013 Program Director: Ruth Orenstein E-mail : rorenstein@exchanizecastle . org Address : 1275 Old Dixie Highway Telephone : 772-567-5700 Vero_ Beach, Fl, 32960 Fax: 772-567-7133 Program Title: Safe Families Priority Need Area Addressed: Focus Area II - Parental Support and Education Brief Description of the Program : Taxonomy # PH-610. 330 - Home based parent education and support designed to prevent child abuse and neglect and help families remain intact Through Iong term (up to one year) intensive (at least weekly) visits from a counselor, families learn to reduce risk factors associated with abuse and neglect and increase the protective factors associated with non abusive, caring and stable families . SUMMARY REPORT — Enter Information In The Black Cells Only) Amount Requested from Funder for 2006 / 07 : $ 47 , 080 . 00 Total Proposed Program Budget for 2006 /07 : $ 3293367 . 88 Percent of Total Program Budget : 14 . 3 % Current Program Funding (2005 /06 ) : $ 40 , 619 Dollar increase /( decrease ) in request : $ 6 , 461 Percent increase / ( decrease ) in request * : 15 . 9 % Unduplicated Number of Children to be served Individually : 200 Unduplicated Number of Adults to be served Individually : 133 Unduplicated Number to be served via Group settings : 54 Total Program Cost per Client : 851 . 08 *If request increased 5 % or more, briefly explain why: Addition of parenting classes; increased cost of facilities. If these funds are being used to match another source, name the source and the $ amount : United Wav Indian River County: $89,663 • United for Families : $ 120.000 . The Organization 's Board of Directors has approved this application on (date). 1/24/06 Michael Dillman -4 A , D ow Name of President/Chair of the Board Signature Theresa Garbarino-May Name of Executive Director/CEO ,/Signature 3 t Organization: Exchange Club CASTLE Program Name: Safe Families Funder: Children's Services Advisory Committee RFP# 2006061 ORGANIZATION: ExchanlZe Club CASTLE PROGRAM: Safe Families 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 Proposal Pa e # X TABLE OF CONTENTS (check list) 1 X COVER PAGE (with signatures). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 A. ORGANIZATION CAPABILITY (one page maximum) X 1 . Mission and Vision of organization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 X 2. Summary of expertise, accomplishments, and population served . . . . . . . . . . . . . . . . 4 B, PROGRAM NEED STATEMENT (one page maximum) X 1 . Program Need Statement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 X 2 . Programs that address need and gaps in service . . . . . . . 6 . . . . . . . . . . . . 66 . . . . . . . . . . . . . . 5 C. PROGRAM DESCRIPTION (two pages maximum) X1 . Funding priority . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 X 2 . Description of program activities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 . . . . . . . . . . . . . . . . . . . 6 X 3 . Evidence that program strategy will work . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 X4. Staffing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 . . . 7 X 5 . Awareness of program. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 X 6 . Accessibility of program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 X D. MEASURABLE OUTCOMES (tivo page maximum) . . . . . . . . . . . 8 X E. COLLABORATION (one page maximum) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 F. PROGRAM EVALUATION (hvo pages maximum) X1 . Demographics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 1 X2 . Measures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 X3 . Reporting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 X G. TIMETABLE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 . . . . . . . . . . . . . . . 13 H. UNDUPLICATED CLIENT COUNT X 1 . Projections by Location . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 X 2. Projections by Age Group . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 1 r Organization : Exchange Club CASTLE Program Name : Safe Families Funder: Children' s Services Advisory Committee RFP# 2006061 I. BUDGET FORMS X 1 . Financial Budget Forms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 X FUNDER SPECIFICADDITIONAL SHEETS/APPENDIX. . , . . . . . . 24 2 Organization : Exchange Club CASTLE Program Name: Safe Families Funder: Children' s Services Advisory Committee RFP# 2006061 PROPOSAL NARRATIVE A. ORGANIZATION CAPABILITY (Entire Section A not to exceed one page) 1 . Provide the mission statement and vision of your organization. The mission of the Exchange Club CASTLE is to improve the quality of family life while preventing child abuse and neglect, by providing community education, support and resources for families in need of assistance. The CASTLE envisions a community where each child is allowed to grow to his or her full potential, free from abuse and neglect, and families have access to the supports they need to create healthy living and learning environments for children. FProvidebrief summary of your organization including areas of expertise, ments , and population served. CASTLE is celebrating its 25th year of providing child abuse prevention ilies on the Treasure Coast, and Okeechobee. Starting in 1981 with one staff of three, the CASTLE has grown, and now offers an array of prevention services which have been added as the needs of the community change and develop . The CASTLE ' s core program, Safe Families, remains an industry leader, and has set the benchmark for quality in-home services that produce results and keeps families together. More than 100 child abuse centers in 27 states utilize the Safe Families model that was implemented in Fort Pierce in 1981 , by those three CASTLE employees . CASTLE services are accredited by the national Council on Accreditation, and this year, the CASTLE will also be seeking accreditation from the National Exchange Club Foundation. All CASTLE services utilize a continuous quality improvement (CQI) model to monitor and improve the delivery of services. This model includes peer reviews, client satisfaction surveys, measurements of program effectiveness, and the use of this information to make improvements . CASTLE services are designed to prevent child abuse and build the capacity of families, through parenting education and family skills building. Our core program Safe Families, offers long term, home based, parenting education. Other programs offered include: Families First, a training seminar for divorcing parents; High Hopes for Kids , offering support to children whose parents have divorced; Positive Parenting, a support group for parents facing difficulties raising their children; Valued Visits, a supervised visitation center; and Strengthening Families, a five agency collaborative that utilizes a group setting to build family skills. The population served is : families who are at risk for abusing or neglecting their children; families who have had a reported incident of abuse or neglect, but who, with support and education, can eliminate further episodes of abuse; families with children 0- 18 ; Families are served county wide, with no geographic restrictions. This year' s demographics indicate that 65% of enrolled families are single parents, 51 % are White, 28% are Hispanic, 17% are Black, and 4% are Haitian . Fifty-eight percent of families served (Safe Families only) are below the federal poverty level . 4 Organization: Exchange Club CASTLE Program Name : Safe Families Funder: Children' s Services Advisory Committee RFP# 2006061 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: The unacceptable condition requiring change is child abuse and neglect. Child abuse and neglect has well-documented, long term, harmful effects on children, including permanent physical injuries, chronic low self esteem, developmental delays, difficulty in forming attachments and relationships, mental illness, aggressive behavior, and a cycle wherein an abused child is much more likely to, in turn, abuse his or her own children. ' Who : Parents who pose a risk to their children, because of identifiable risk factors such as poverty, a lack of parenting knowledge/skills, or a parent' s own history of abuse or addiction. Where: Last year, parents were served in all parts of Indian River County. Provide Data: The overwhelming majority of families that abuse or neglect their children can, with the proper support, learn to parent in a manner that is non- abusive (research shows that home based parent education is the most effective way to prevent abuse and neglect" ") . This allows the family to remain intact and avoid the trauma of an out of home placement for the child . Research indicates that 96-98% of families who engage in home-based parent education programs such as Safe Families, do not re-abuse their children. This reduces by almost two- thirds, the number of children who face further abuse at the hands of their caretakers . " Locally, Indian River County has a child abuse rate of 12. 6 children per 1 ,000 . This is much lower than the state rate of 29. 6 children per 1 ,000, and, for the first time is as low as the national rate ( 12 .4 children per 1 , 000 .)" Clearly, the emphasis Indian River County has placed on prevention is paying a dividend. In conclusion, the data show that 1 ) home based parent education prevents abuse; 2) home based parent education helps children stay out of foster care; 3 ) prevention efforts, when supported by the local community, result in fewer children being abused. 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 . Safe Families serves a population that is not served by the other abuse prevention programs in Indian River County. However, in concert with two other programs, there is a seamless system of prevention efforts that spans all age levels and all risk levels . * CASTLE' s Safe Families serves : Children ages 0- 18, primary and secondary risk levels. Accepts referrals from all agencies and accepts self-referrals . *Healthy Families serves : Pregnant mothers and newborns (up to 15 days old). *Hibiscus (Hope) program serves : Families who are at imminent risk of having their children removed (tertiary risk level) . Accepts only DC&F referrals. These eligibility differences help each program specialize in a particular target population. Duplication is avoided by stringent adherence to the eligibility requirements of each provider. The intake process of all three providers assesses all services in the home, and this acts as another barrier to duplication of services . Safe Families is a program that is in high demand throughout the four county area, with referrals outnumbering available slots by an almost 2 : 1 margin. 5 Organization: Exchange Club CASTLE Program Name : Safe Families Funder: Children's Services Advisory Committee RFP# 2006061 C. PROGRAM DESCRIPTION (Entire Section C, I — 6, not to exceed two pages) 1 . List Priority Needs area addressed. Focus Area II : Parental Support and Education. Promoting programs that focus on individual parenting programs; encouraging agencies to provide age appropriate parenting support. 2. Briefly describe program activities including location of services. 1 . Upon receiving a referral, a counselor visits the family, and assesses the need for home-based parent education (Safe Families). This is accomplished through interview, observation, and completion of an initial needs assessment. To avoid duplication or overlap with other service providers, a review is done of all services being offered to the family. When necessary, and with consent, other service providers are contacted in order to coordinate services to the family. If eligible for Safe Families, the family will begin a program of regular visits, and a family plan, including specific goals, will be developed. The family is an active participant in this process, collaborating on the initial plan for services. 2 . Once a family plan is developed, the counselor makes weekly visits to address the family plan goals . Weekly visits take place for up to one year, with the visits taking place in the family' s home, thus increasing the counselor ' s ability to assess the safety of the children, and evaluate improvements made by the family. Parents remain active participants during the weekly visits, teaming with their counselor to initiate improved parenting techniques. 3 . During the weekly visits, counselors use a multifaceted approach to teaching, including utilizing parenting videos, working through parenting programs , creating behavior management plans, and establishing family meetings, or other formalized methods to improve family communication. Positive discipline and family stability are two over-arching goals. 4 . All weekly visits are geared toward reducing risk factors (characteristics that increase the likelihood that abuse will occur) , and increasing protective factors (characteristics that decrease the likelihood that abuse will occur). Safe Families has identified the following risk and protective factors that form the basis of each counselor' s work with a family: Risk Factors: Additional parenting knowledgelskills needed, Parents history of abuse as a child; Parents history ofsubstance abuse; Parents history ofinental health issues; Domestic violence — past/present (victim/perpetrator); Inability to meet basic needs; Teen, young or non-traditional parent; Lack ofsupport system; Parents/children with physical handicaps or other diagnosable conditions. Protective Factors: Housing stability; Delay ofsubsequent pregnancy; Enrollment in childcare; Enrollment in healthcare; Child receives routine medical care; Livable wage employment; Active participation in child 's school, Positive family communication; Constructive use of time; Supportive adults outside offamily. 5 . Frequent supervisory review and a regular peer review ensure that each family is continually evaluated for the frequency and intensity of services needed. 6. Follow-up occurs for three months after closure of the case . Monthly visits are paid to the family to ensure the continued use of techniques learned. In addition, the Department of Children and Families tracks families for one year after completion of services to determine if re- abuse has occurred. Follow-up may also include parent education groups. 7. Parent Education Groups — Positive Parenting will augment the Safe Families home based intervention. Positive Parenting will consist of 12- 18 hours of parenting education classes. Enrollment in the class will be available to 1 ) those on a waiting list for Safe Families; 2) parents who do not need the intensity of in-home services ; and 3) parent who have completed Safe Families, but continue to need follow-up services. These classes allow parents time to separate from the support of an in-home counselor, reduce isolation, and solidify their newly learned techniques. Parenting groups will be held at the CASTLE office in Indian River County, during day, evening or weekend hours, on a rotating basis. 6 Organization: Exchange Club CASTLE Program Name: Safe Families Funder: Children ' s Services Advisory Committee RFP# 2006061 3 . Briefly describe how your program addresses the stated need/problem. Describe how your program follows a recognized "best practice" and provide evidence that indicates proposed strategies are effective with target population. The stated need or problem is child abuse and neglect. Safe Families prevents child abuse and neglect by replacing patterns of abusive behaviors with non-violent, positive approaches to parenting ; and by establishing long term supports so that families remain abuse free long after involvement with the program ends . The family' s relationship with their counselor is a critical element to the success of the program. Over the course of the program, the counselor guides, supports, and teaches the parent to create a nurturing, healthy environment for their children. Best practices for home visiting programs include intensive services over a long period of time, a focus on parenting skills, frequent observation of the home situation, and frequent review of the family to determine the need for and intensity of the service. Safe Families incorporates all of these best practices .` Here are conclusions from six independent studies that demonstrate the effectiveness of the home-based model of preventing child abuse and neglect: "There is strong evidence to recommend home visitation to reduce child maltreatment""" "Home visiting has a higher retention rate (70-90%) than center-based services (60-70%) "The positive effects of early home visitation re-emerge when the children reach age 8 "" "In Pinellas County Florida, parents enrolled in a home visiting program had abuse rates of 1 .6% as opposed to non-enrollees who had a rate of 4. 9%"x "Home visiting programs that target high risk and/or low income mothers and children are effective and return from $6,000 to $ 17,200 per youth"x' "Home visiting is an effective method to prevent the re-abuse of children""" In addition, the CASTLE is participating in a national study on the effectiveness of the Safe Families model of child abuse prevention that will begin in the fall of 2006 . 4. List staffing needed for your program, including required experience and estimated hours per week for each staff member and/or volunteers (this section should conform to the information in the Position Listing on the Budget Narrative Worksheet). Safe Families Program Manager — 22% of time - MA/2yrs. supervisory experience in field. Safe Families Supervisor — 22% of time - BA/lyr. supervisory exp . in field. Safe Families counselors (3 . 0 FTE) — 100% of time - BA/2 years exp. in services to families . Parent Ed. Sup ./Case Mgr. 36% of time — 2yrs . teaching exp. Facilitator 100% of time 1 yr. exp . Secretary/Receptionist — (3 ) 67% of timel year secretarial experience. HR Specialist 13 % of time - BA — 2 years HR exp. Bookkeeper 10% of time 2 yrs. exp. Development Director/Comm. Rel . Coord. 11 % of time — 2 years experience. 5. How will the target population be made aware of the program? Families are made aware of the program through referrals from agencies, schools, parents, the Dept. of Children and Families, and United for Families. In addition, the CASTLE participates in local outreach/networking efforts; the CASTLE participates in National Child Abuse Prevention Month; and the CASTLE affiliates with many local businesses through fund raising. 6. How will the program be accessible to target population? Families are visited in their homes, with no required visits to the CASTLE administrative offices . To enroll in the program, all a parent must do is call the office. An intake screening is done over the phone. If the family seems appropriate for Safe Families, a home visit is scheduled within the next 48 hours . Referrals from other sources are accepted by fax or by mail. CASTLE offices are opened from 8 : 00am - 5 : 00pm. Home visits are scheduled weekdays, and weekday evenings . 7 Organization: Exchange Club CASTLE Program Name: Safe Families Funder: Children ' s Services Advisory Committee RFP# 2006061 D. MEASURABLE OUTCOMES (Entire Section D not to exceed two pages) NEXT YEAR 10/06-9/07 OUTCOMES ACTIVITIES Add all o the elements for the Measurable Outcomes) Add the tasks to accomplish the Outcome(s) 1 . Reduce the risk factors associated with child 1 . Provide information and education abuse for families in the Safe Families program regarding identified risk factors, during home by at least one, during enrollment in the visits, so that major risk factors are reduced or program and /or at the conclusion of the eliminated . program, for 95 % of families who have been enrolled at least 3 months, as measured by a risk assessment tool (see appendix). No more than 5% of families who have been enrolled for 3 months or more will show no (zero) risk factor reduction. 2004/2005 baseline: 97. 6% of families reduced at least one risk factor. 2 .4% showed no risk factor reduction. 2. Maintain the reduction in risk factors (by at 2 . Conduct monthly follow-up visits for 3 least one) for a period of 90 days after months after services have been completed. At enrollment, for families who have successfully the end of this 90 period, complete the risk completed the program, as measured by a risk assessment tool. Compare the results of the assessment tool (see appendix) in 95% of follow-up assessment to the previous families . No more than 5 % of families who assessment done at the close of service. have successfully completed the program will fail to maintain a risk factor reduction. 2004/2005 baseline: 100% of families maintained their risk factor reduction. 3 . Increase the protective factors associated 3 . Provide information and education with a reduction in the risk of child abuse for regarding identified protective factors, during families in the Safe Families program by at home visits, so that major protective factors are least one, during enrollment in the program increased and/or improved upon. and /or at the conclusion of the program, for 95 % of families who have been enrolled for at least 3 months, as measured by a protective factor assessment tool (see appendix). No more than 5% of families who have been enrolled for at least 3 months will fail to increase at least one protective factor. 2004/2005 baseline 100% of families increased at least one protective factor. 8 Organization: Exchange Club CASTLE Program Name: Safe Families Funder: Children's Services Advisory Committee RFP# 2006061 OUTCOMES-NEXT YEAR 10/06-9/07 ACTIVITIES Add all of the elements for your Measurable Outcome(s) Add the tasks to accom lisp the Outcomes 4 . Maintain the increase in protective factors 4. Conduct monthly follow-up visits for 3 (by at least one) for a period of 90 days after months after services have been completed. At enrollment for families who have successfully the end of this 90 period, complete the risk completed the program, as measured by a assessment tool. Compare the results of the protective factor assessment tool (see follow-up assessment to the previous appendix) in 95% of families . No more than assessment done at the close of service. 5% of families who have successfully completed the program will fail to maintain an increase in at least one protective factor. 2004/2005 baseline: 100% of families maintained their protective factor improvement. 5 . 94%, of families who complete the Safe 5a. Provide information and education Families program will have no confirmed regarding identified risk and protective factors, reports or re-reports of abuse for up to one year during home visits, so that parents develop the after completing services as measured by the skills necessary to eliminate abuse/neglect as a state data base on abuse . No more than 6% of risk in their home. the families who complete the Safe Families program will have a confirmed report or re- 5b . The Department of Children and Families report of abuse for up to Two years after will compare the names of families who completing services. 2004/2005 baseline : complete the Safe Families program against 97 .6% of families were not reported or re- those reported for abuse/neglect to the state reported for abuse. (Longer follow-up abuse hotline, and provide the program with recommended by UW panel last year). this information. 6. 96% of families, after successfully 6. The AAPI test will be administered at the completing the Safe Families program, will initiation of and at the conclusion of services. show improvement on the AAPI test, as Scores will be compared to determine whether measured by comparing their pre-test score to improvement has been made . their post-test score . No more than 4% of families who, after successfully completing the program, will have no increase in a post test score. 2004/2005 baseline : 98 . 8% of families who successfully completed the program improved on their post test AAPI scores . 1 .2% did not improve. 7. Conduct parenting education classes . 7. Ninety percent of parents participating in Evaluate the participants ' understanding of the the parenting education services (groups) will class material at the end of each session. demonstrate an improved knowledge of parenting issues, as measured by a survey after each group session. Baseline : This is a new goal, baseline to be determined. 9 Organization: Exchange Club CASTLE Program Name : Safe Families Funder: Children 's Services Advisory Committee RFP# 2006061 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 agree nt letters.) Collaborative Agency Resources providedtothe program United For Families CASTLE staff serves on the Board of Directors of UFF; Agencies jointly advocate for adequate funding; CASTLE assists in the on-going implementation of the utilization management system developed by UFF. Children ' s Home Society/Family Share relevant case information when necessary to assist Preservation Services . families; ensure that there is no dual enrollment through intake/assessment process and information sharing. Healthy Families Share relevant case information when necessary to assist families; ensure that there is no dual enrollment through intake/assessment process and information sharing; participate jointly in advocacy efforts to support child abuse prevention programs. Department of Children and Share relevant case information when necessary to assist Families families; ensure that there is no dual enrollment through intake/assessment process and information sharing. Provide a list of families where abuse or re-abuse has occurred. Treasure Coast Food Bank CASTLE will continue to host a food pantry for emergency food distribution. 4-C club CASTLE will distribute 4-C club vouchers for clothes and shoes to clients in need. Hibiscus Children' s Center Share relevant case information when necessary to assist families; ensure that there is no dual enrollment through intake/assessment process and information sharing; participate jointly in advocacy efforts to support child abuse prevention programs. 10 Organization: Exchange Club CASTLE Program Name: Safe Families Funder: Children ' s Services Advisory Committee RFP# 2006061 F. PROGRAM EVALUATION (Entire Section F not to exceed hvo pages) F HICS : What information (data elements) will you need to collect in order describe your target population including demographics (age, gender, and round) required by the funder in Section H? What are the pieces of hat qualify them for your target population ? How do you document their ces or their "unacceptable condition requiring change" from Section Bl ? Age, gender, ethnicity, marital status, and address are collected upon intake. Eligibility for the program requires that parents pose a risk to their children, because of an identifiable risk factor such as poverty, lack of parenting knowledge and skills, or a parent' s own history of abuse, addiction or family violence. Families must exhibit at least one risk factor to be eligible for enrollment. Families must have children living in the home who are between the ages of 0- 18 . There is a three step process to documenting the need for service. First, a referral is reviewed by the program supervisor. This may include a discussion with the referral source to gather additional information. Second, if the client appears eligible from the first review, a home visit by a Safe Families counselor is scheduled. At this visit, an initial needs assessment (INA) is completed. Finally, the results of the INA are reviewed with the Program Supervisor, and eligibility is determined. 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? Outcome 1 (to reduce risk factors associated with abuse) is measured by a risk assessment tool that lists the risk factors identified at intake (see appendix). Identified risk factors become the focus of intervention until they are resolved. Risk is assessed at least quarterly Outcome 2 (to maintain the reduction in risk factors) : This is a follow-up measure . The risk assessment tool is used again ninety days after program completion, to see if the reduction in risk factors shown at the end of service is being maintained. Outcome 3 (to increase protective factors associated with a lower risk of child abuse) ' is measured by a protective factor assessment tool that lists the protective factors identified at intake, and subsequently (see appendix). Identified protective factors are a focus of intervention once risk factors have been reduced . Protective factors are assessed at least quarterly. Outcome 4 (to maintain the increase in protective factors) ' This is a follow-up measure. The protective factor assessment tool is used again ninety days after program completion, to see if the increase in protective factors shown at the end of service is being maintained . 11 Organization: Exchange Club CASTLE Program Name : Safe Families Funder: Children' s Services Advisory Committee RFP# 2006061 Outcome 5 (no re-reports of abused is measured by the state database on abuse. Families who complete the Safe Families program are checked to see if there have been any subsequent reports to the child abuse hotline. This check is done quarterly. Outcome 6 (improve on post test score) : is measured by the AAPI (Adult Adolescent Parenting Inventory) which is a nationally accepted standardized test that measures parent attitudes and beliefs . Low scores are associated with an increased risk of abuse; high scores are associated with a lower risk of abuse . The test is administered during intake, and prior to closure. Outcome 7 (knowledge gained from parentinggroups) : is measured by administering survey questions to group participants at the end of each parenting class. The questions will relate directly to the topic presented. Other data collected include satisfaction surveys from all clients , and completion of family plan goals for each family. 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? Information collected is used to measure the progress of enrolled families, and to help determine the length and content of the intervention. Families are aware of their progress on the AAPI, risk/protective factor checklist, and family plan goals and counselors utilize their progress to motivate participants . The CASTLE operates under a Continuous Quality Improvement model (CQI). The outcomes of all programs are reviewed quarterly through a "Service Delivery" committee. The Service Delivery committee then recommends program improvements which are implemented by the Program Manager. Results from collected information are reported to funders on a regular basis through monthly, quarterly or semi-annual reports . Staff, Board members, and other stakeholders are made aware of results through the CQI process, and feedback at all-team and Board meetings. The community is made aware of results through an annual report. Later this year, the program is participating in a national study of the Safe Families model of home based parent education. 12 Organization: Exchange Club CASTLE Program Name: Safe Families Funder: Children' s Services Advisory Committee RFP# 2006061 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 October 1 , 2006 Safe Families is a continuing program and will be fully staffed and in full operation at the start of the contract year. Regarding the program operation: 1 . Referred families are contacted within 48 hours. 2 . Referred families are assessed within 14 days . 3 . A family plan is developed within 30 days . 4. Weekly visits take place for up to one year. 5 . Monthly and quarterly progress reports track client progress . 6. Post testing and protective/risk factor assessments take place near the end of services. 7 . Follow-up is done for three months after case closure. October 1 , 2006 8 . Parent education services (groups) are offered to families who do not need the intensity of home visitation services, are on a waiting list, or need additional follow-up in a supervised setting to remain abuse free. 13 Organization: Exchange Club CASTLE Program Name: Safe Families Funder: Children's Services Advisory Committee RFP4 2006061 H. PROJECTIONS FOR UNDUPLICATED CLIENTS Number of Unduplicated Clients by Location ��> seaer Current Fiscal Year Nxtfis5 Year ' Location r Aeiva1104l2 Budget 2005/06 PrnJectiotrs006707 , Unduplicated Clients Unduplicated Clients Unduplicated Clients N. Indian River County 89 128 128 S. Indian River County 180 259 259 Indian River Co. Total 269 387 387 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 269 387 387 Number of Unduplicated Clients by Age fPI NMI- a $ a> �c0r Current Fiscal Year Netrscl Ycar Location I ,if " ( � i v� Ig ctrraq© Budget 2005/06 ZIP mg _ rtlectront►06f1 ndrrla�sp ~ Individual Group inclydual olW 6 . e , _. . _ r 0 to 4 - (Pre-school) 61 75 - 75 - 5 to 10 - (Elementary) 45 - 55 - 55 - 11 to 14 - (Middle) 37 45 45 15 to 18 - (High School) 21 25 25 - Total Children 164 200 - 200 - 19 to 59 - (Adults) 97 - 123 54 123 54 60 + (Seniors) 8 - 10 - 10 TotalAdults 105 - 133 54 133 54 TOTAL SERVED 269 - 333 54 333 54 14 Exchange Club CASTLE Safe Families 2006-2007 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 : Exchange Club CASTLE / Safe Families FUNDER : Children 's Services Advisory Committee - Indian River County _ . . . . . . . . . . . _ . . _ . - _ . . _ . - _ . . _ . . _ . . _ _ . . . . . . . . . . . . . . - . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . CAUTION : Do not enter any figures where a cell is colored in dark blue - Formulas and/or links are in place- Gray areas should btj : used for providing information and calculations only. REVENUES Proposed Total Program Budget Funder Specific Budget Total Agency Budget 11 Children's Services Council-St. Lucie 414,226. 00 2 Children's Services Council-Martin 170,358.00 3 Advisory Committee-Indian River 47,080.48 47, 080.48 62,276.48 4 United We -St. Lucie Court65,330.00 5 United Wa -Martin County 40,229.00 6 United Way-Indian River Coun 89, 663. 25 132,839. 00 7 United For Families 120, 000. 00 s35,ase.00 8 County Funds 9 Contributions-Cash 25, 000.00 92,95400 10 Program Fees 2,500.00 55,200.00 11 Fund Raisin Events-Net 3D, 00N0 200, 000.00 12 Sales to Public - Net 13 Membership Dues 14 Investment Income 10,000.00 15 Miscellaneous 7,500.00 16 Legacies & Bequests 17 Funds from Other Sources 15, 124. 15 396,719.30 18 Reserve Funds Used for Operating 19 In-Kind Donations (Not included in total) 20 TOTAL REVENUES (doesn't include line 19) $329,367. 88 $47,080.48 $2, 183, 099.78 A B C . EXPENDITURES Proposed Total Program Budget Funder Specific Budget Total Agency . Budget 21Salaries ud et21Salaries - (must complete chart on next page 161 , 521 . 001 32,200.00 1 , 146, 814.00 22 FICA - Total salaries x 0.0765 12, 356, 001 2,463. 30 87, 731 .27 Retirement - nnua pension orquai le 23 staff 61508. 82 1 , 750.00 40, 000. 00 Life/Health - Medlcal/Dental/Short-term 24 Disab. 10, 895. 40 2,400.001 40, 000.00 Workers Compensation - *employees x 25 rate 5,463 .78 836.21 41 ,300.59 Florida Unemployment - proles e 26 employees x $7,000 x UCT-6 rate 577.80 0.00 5, 508. 00 512212005 15 e-t Exchange Club CASTLE Safe Families SALARIES I Gross a /V POSITION LISTING Annua/ Salary Portion of Salary on Proposed f/l Funder % of Gross Annual Position Budget on Title/ Total Hrs/wk (Agency) Program p g Salary Requested(CIA) Example: ExacuOve Director140ims 70,000.00 10, 000.00 5,000.00 7.14% Secretary, Madden 26, 996. 00 4, 770. 08 0.00 0.00% Receptionist, Lewis 23,968.00 3,888. 32 0.00 0.00% Human Resources, Cleveland 33,908. 00 4, 540.32 0. 00 0. 00% Receptionist, Taber-Dunnin ton 24, 000.00 12,734.00 0. 00 0. 00% Director Development 51 , 998.00 6,441 . 04 0.00 0.00% Comm. Relations Coord. 36,400. 00 3,909.28 0.00 0. 00% Comm. Relations Coord. 32,500. 00 3,441 .28 0. 00 0. 00% Bookkeeper 27, 000.00 2,777.68 0. 00 0. 00% Program Manager, Orenstein 43, 141 .00 9, 584. 60 0.00 0. 00% Supervisor 35,368. 00 8,030. 00 2, 500.00 7 .07% Counselor, Sudbrock 30,804. 00 30, 804.00 10,000. 00 32.460A Counselor, Pachon 251, 158.00 25, 158. 00 10,000.00 39.75% Counselor, Shottland 34, 1792.00 34,092.00 4, 500. 00 13. 20% Parent Ed , Manager 8,700. 00 1 ,000. 00 0.00 0. 00% Parent Ed , Case Manager 19, 300. 00 4, 750.00 0.00 0. 00°/ Parent Ed, Facilitator 7, 200.00 5,600.00 5, 200.00 72.22% #DIV/0! Remaining positions throughout the agency 686,281 . 00 Total Salaries $1 , 146, 814. 00 $161 , 520. 60 $32,200.002.81 % FRINGE BENEFITS DETAIL (Funder Specific Budget I Funder If in N v vl vlf Column G only, from line 21 to 26) SpecificPension Worker's flnemp/oyme Total Fringes Funder Budget FICA Z65% Health Ins. Complains. nt Compens. Specific Position Title / Total Hrs/wK Example: Case Manager/ 40line 5,000.00 382:50 200.00 300.00 300.00 - " 200.00 1,582.50 Secretary, Madden 0.00 0.00 0.00 Receptionist, Lewis 0.00 0.00 0.00 Human Resources, Cleveland 0.000.00 0.01: Receptionist, Tober-Dunnington 0.00 O.OD 0.00 Director Development 0.00 0.00 0.00 Comm. Relations Coord . 0.00 0.00 0.00 Comm. Relations Coord. 0.00 0,00 0.0D Bookkeeper 0.00 0.00 0.00 Program Manager, Orenstein 0.00 0. 00 0.0D Supervisor 2,500.00 191 .25 500.00 600.00 150 .00 1 ,441 .25 Counselor, Sudbrock 10,000.00 765.00 500.00 600.00 175.00 2, 040.0( Counselor, Pachon 10,000.00 765.00 500.00 600.00 175.00 2,D40.0D Counselor, Shottland 4,500.00 344.25 250.00 61 0.001 175.00 1 ,369.25 Parent Ed, Mane er 0.00 0.00 0.00 Parent Ed, Case Manager 0.00 0.00 0.00 Parent Ed , Facilitator 5,200.00 397.80 1 161 .211 9.01 Total Funder Request Fringe Benefits $32,200.00 $2,463.301 $ 1 750.001 $2,400.001 $836.211 $0.001 MMMMM$7,449.51 A Proposed B C Ff XPENDITURES Total Program Budget Funder Specific Budget Total Agency Budget 27Daily 12 ,636. 00 0.00 42,320. 00 ff x average # of miles/wk x 50 wks x imated Daily Travel/Mileage Reimb. 374 miles/weeks@ .34lmile 28ConferencesIrraining 2, 174.88 25,044.00al Conference (cost perstaff)g/Seminar (cost per staff)Trainings (cost of travel, lodging, tion, food) Training and conferences for 3 employees, travel and meals, etc 5/222006 B-1 16 Exchange Club CASTLE Safe Families non 28 Office Supplies 5,438 . 001 750. 001 25, 000. 00 Office supplies (monthly average x 12 months = estimated cost of office supplies based on present history. $453/month, copy paper, pens, pencils, etc 30 Telephone 8, 604. 001 46, 800. 00 # Phone lines x average cost per month x 12 months = local phone cost • Average long distance calls x 12 months = Estimated costof long distance $492/month, incl cell phone, local, long distance, internet, etc. 31 Postage/Shipping 2, 214.401 81460.00 • Quarterly Mailing of Newsletter • Special events, etc: • Bulk mailings -appeals $185/month for quarterly newsletter mailing, general mailing, and special events mailing, etc. 32 Utilities 81400.00 341120. 00 • Electricity ($ x-12 months) • Water/Sewer ($ x 12 months) • Garbage ($ .x 12 months) $272/month, electric, water, etc 33 Occupancy (Building & Grounds) 23 ,676. 001 5, 180.971 126 , 972 . 00 • Mortgage/Rent ($ x. 12months) • Janitorial (S z 12 months) • Grounds Maint. ($ x 12 months) • Real Estate Taxes $1693/mopnth, rent, cleaning, grounds, pest control, etc, 34 Printing & Publications 3, 739. 92 21 , 966. 00 • Quarterly Newsletter ($ x 4) • Letterheads, Envelopes, etc. . • Fundraising materials • Other Quarterly newsletter, letterhead envelopes, special events materials, etc. 35 Subscription/Dues/Memberships 381 .481 1 2,929.00 • Membership to National Organization • Dues • Subscriptions to Newspapers/magazines, etc Memberships, dues, subscription to magazines and organizations, etc. 36 Insurance 4,038. 121 1 , 500.001 19, 171 . 00 • Directors/Officers Liab: • Commercial/General insurance ' .Bond Ins. -Auto Insurance Directors, Liability, auto, etc. 37 Equipment: Rental & Maintenance 7, 164.00 37,260. 00 • Copier. lease ($ z 12 months) •. Meter lease S x 12 months) • Copier Maintenance ($ x 12 months) • Computer Maintenance ( $ x 12 months) • Other Copier lease $340/month, meter lease $ 381/quarter, computer maintenance $350/month, copier maintenance, etc. 38 Advertising 2,356.241 1 15,312.00 Newspaper ads' Fundraising(ads/promotions '. Other (vacancies) Help wanted ads, Fundraising and promotions ads, etc. 39 Equipment Purchases:Capital Expense 4,000. 00 12, 000. 00 • Computer/monitor (#. X$) • Laser Printer Update computers 40 Professional Fees (Legal, Consulting) 3,940.00 • Legal advice ('estimated #hrs x $) • Consultant fees •. Other 41 Books/Educational Materials 1 , 108. 16 25, 144. 00 • .Booksivideos • Materials ($. x staff) Update books and materials for clients and staff 42 Food & Nutrition Meals (# meals x clients x 5days x 50. wks) Snacks . 43 Administrative Costs 41 ,297.00 199,650.92 • Admin. Cost (% of total budget) 44 Audit Expense 978.80 5 ,500. 00 5rz2rz0=6 17 B-' Exchange Club CASTLE Safe Families • Independent Audit Review Annual independent audit 45 Specific Assistance to Individuals 920.001 8,518.00 • Medical assistance • Meals/Food • Rent Assistance • Other Rent assistance, utility assistance, etc. 46 Other/Miscellaneous 418.481 5,479. 00 • Backgroundcheck/drug test • Other - Background/drug screening 47 Other/Contract 2, 500. 001 156, 160. 00 Sub-contract for program services Development and marketing contracts, eta 48 TOTAL EXPENSES $329, 367. 88 $47 ,080 .48 $2, 183,099.78 18 M2rzons s-1 e h.19• Cw CnsnE 2007 UNIFORM GRANT APPLICATION TOTAL AGENCY BUDGET AGENCYIPROGRAM NAME: EXCHANGE CLUB CASTLE / SAFE FAMILIES FY04105 FY 05/06 FY 06/07 % INCREASE FYE 9130105 FYE 9130106 FYE 9130107 CURRENT VS. NEXT FY BUDGET A B C D ACTUAL TOTAL PROPOSED (Col. ccol. Bycol. 8 REVENUES BUDGETED BUDGETED 1 Children's Services Council-St. Lucie 159.490.531 202,500.001 414.226.001 104.560A 2 Children's Services Council-Martin 126277.47 167483.00 170,358.00 1 .72% 3 Advisory Committee-Indian River 42,570.39 60,000.00 62,276.48 3.79% a United Way-St Lucie Coun 56 000.01 65 000.00 65.330.00t 0.51 % 5 United Way-Martin County40 140.75 40 000.00 40 229.00 0.57% 6 United Way-Indian River County104,333.67 126000.00 132,839.00 5.43% 7 United For Families 360268.28 371668.50 535468.00 44.07% 8 Coun Funds 0.00 #DIV/0! 9 Contributions-Cash 78.042.681 loo.000.001 92,954.00 -7.05% 10 Pro ram Fees 47.450.83173.780.001 55 200.00 .25.18% 11 Fund Raising Events-Net 168,033.991 162.000.001 200000.001 23.46% 12WFundd o Public-Net 0.00 #DIV/0! 13Membership Dues 0.00 #DIV/01 14ent Income 15176.97 10000.00 10,000.00 0.00% iSaneous 4414.77 5,000.00 7500.00 50.00% 16 Legacies & Bequests 0.00 #DIV/01 17rom Other Sources 640991 .40 375853.60 396,719.30 5.55% 1e e Funds Used for O eratin 0.00 #DIV/0! 19Donations [Net Included �n total) 0.00 #DIV/01 20 1 ,843,191 .741 1 ,759 285.10 2,183 099.78 24.09% EXPENDITURES 21 Salaries 915,169.211 840 819.79 1 ,146.814.001 36.39% 22 FICA 66,997.80111 64.322.711 87J31 .27I 36.3907 23 Retirement 40,732.501 40.000.001 40.000.001 0.00% 24 Life/Health 54.731 .671 52.020.001 40000.00 -23.11% 25 Workers Compensation 13,257.401 13.396.1351 41 ,300.591 208.29% 26 Florida Unemployment 13.031 5,000.001 5.508.001 10.16% 27 Travel-Daily 25,352.571 32.100.001 42.320,001 31 .84% 28 Travel/ConferenceslTrainin 18. 133.511 22.000.001 25,044.00 13.84°/, 29 Office Supplies 34.206.581 22.500.001 25,000.001 11.11 % 30 Telephone 28,350.401 31 ,452.001 46.800.001 48.800A 31 Postage[Shipping 5,363.541 12,440.001 8460.00 -31 .99% 32 Utilities 14,450.251 22.920.001 34. 120.001 48.87% 33 Occupancy (Building & Grounds 55,268.971 98.285.001 126.972.001 29.19% 34 Printing & Publications 17,951 .731 32640.00 21966.00 -32.700/c 35 Subscription/Dues/Memberships 4,704.351 4000.00 2929.00 -26.78% 36 Insurance 17,354.681 19 000.00 19 171 .00 0.90% 37 Eui ment:Rental & Maintenance 33.969.701 17810.00 37260.00 109.21 % as Advertisin 24,213. 151 10 000.00 1531200 53.12% 39Equipment Purchases:Ca ital Expense 10,295.071 34250.00 12000.00 -64.96% 4C Professional Fees (Legal, Consulting) 11 .237.421 13,800.00 3940.00 -71.45% 41 Books/Educational Materials 12,251 .071 31 .805.001 25, 144.00 -20.94% 42 Food & Nutrition 0.001 #DIV/01 43 Administrative Costs 189.637.791 199,650.921 5.28% 4a Audit Expense 9,520.001 5.500.001 5,500.001 0.00% 45 Specific Assistance to Individuals 6,423J1 7.510.00 8 518.00 13.42% 46 Other/Miscellaneous 91538.12 8,576.16 5,479.00 -36.11 % 47 Other/Contract 61r140.09 12751 0.00 156 160.00 22.48% 48 TOTAL 1 490 626.52 1 ,759,285.10 2 183 099.78 24.09% 4s REVENUES OVER/ UNDER EXPENDITURES 352 565.22 0.00 0.00 #DIVlO! 19 1z.� Exchange Cvb CAsn=- s.re r., ,I,, vasmor UNIFORM GRANT APPLICATION TOTAL PROGRAM BUDGET AGENCY/PROGRAM NAME: EXCHANGE CLUB CASTLE I SAFE FAMILIES FY 04105 FYWoe FY 06107 % INCREASE FYE 9130105 FYE 9130106 FYE 9/30107 CURRENT VS. NEXT FY BUDGET A B C D ACTUAL TOTAL PROPOSED (col. (Eool. 13)1col. B REVENUES BUDGETED BUDGETED 1 Children's Services Council-St. Lucie 0.00 0.00 #DIVIO! 2 Children's Services Council-Martin 0.00 0.00 #DIVIO! 3 Advisory Committee-Indian River 36,045.65 45,000.00 47 080.48 4.62% 4 Wary-St. Lucie Coun 0.00 0.00 #DIVl01 5 Way-Martin County 0.00 0.00 #DIV101 6 Way-Indian River Coun 74,583.38 85 000.00 89 663.25 5.49% 7Department of Children & Families 66 131 .15 64 742.02 120 000.00 85.35% 6County Funds 0.00 #DIVIO! 9utions-Cash 1500.00 10000.00 25000.00 150.00% 10m Fees250000 #DIV/0! 11 aisin Events-Net 750.00 20,000.00 30 000.00 50.00% 12 Sales to Public-Net 0.00 #DIVIO! 13 Membership Dues 0.00 #DIV101 14 Investment Income 0.00 #DIVl0! 15 Miscellaneous 0.00 0.00 #DIV101 16 Le acies & Bequests 0.00 #DIV/O! 17 Funds from Other Sources 11 955.52 15 124.15 26.50% 18 Reserve Funds Used for O erating 0.00 #DIV/0! is In-Kind Donations (Notmam.4 in total) 0.00 #DIV101 20 TOTAL 179,010.18 236,697.54 329367.88 39.15% EXPENDITURES 21 Salaries 112383.37 120446.67 161521 .00 34. 10% 22 FICA 8,597.33 10 267.27 12 356.00 20.34% 23 Retirement xxxxxxxxxe 40318.46 6,508.82 6,508.82 0.00% 24 LifelHealth 10 262.28 7,350.07 10r895.40 48.24% 25 Workers Compensation 970.04 11740.44 5463.78 213.93% 26 Florida Unemployment 516.84 577.80 11 .79% 27 Travel-Daily 41213.95 4 912.36 12,636.00 157.23% 28 Travel/Confemncesrrrainin 1 ,384.39 2087.74 2174.88 4.17% 29 Office Supplies 2,089.981 4,502.06 51438-00 20.797/6 30 Telephone 2 775.65 4,601 .24 8y604.00 86.99% 31 Postage/Shipping 1998.91 2497.60 2214.40 -11 .341/6 32 Utilities 11593.87 331672 840000 153.26% 33 Occupancy (Building & Grounds 8171 .59 13379.42 23676.00 76.96% 34 Printing & Publications 3966.44 4894.80 3739.92 -23.59% 35 Subscri tion/DueslMembershi s 280.08 492.00 381 .48 -22.46% 36 Insurance 2,584.37 2984.48 4038.12 35.30% 37Equipment: Rental & Maintenance 3457.08 4319.88 7164.00 65.84% 36 Advertising 838.46 1 ,618.26 2356.24 45.60% 39Equipment Purchases:Ca ital Expense 1853.30 1400.00 4000.00 185.71 % 40 Professional Fees (Legal, Consulting) 0.00 0.00 0.00 #DIV/0! 41 Books/Educational Materials 239.48 880.60 1 108. 16 25.84% 42 Food & Nutrition 0.00 #DIVIO! 43 Administrative Costs 35,454.96 41 297.00 16.48% 44 Audit Expense 380.65 992.86 978.80 -1 .42% 45 Specific Assistance to Individuals 677.61 892.46 920.00 3.09% 46 Other/Miscellaneous 41 .60 208.90 418.48 100.33% 47 Other/Contract 5931 .29 431 .09 2500.00 479.93% 48 TOTAL 179 010.18 236 697.54 329136B.213 39.15% 49 REVENUES OVER/ UNDER EXPENDITURES 0.00 0.00 -0.40 #DIV10! 20 sazooc e, Exchange Club CASTLE Sate Families 2006-2007 UNIFORM GRANT APPLICATION FUNDER SPECIFIC BUDGET PROGRAM EXPENSES AGENCY/PROGRAM NAME : EXCHANGE CLUB CASTLE / SAFE FAMILIES FUNDER : Children 's Services Advisory Cor A B C FY 06/07 FY 06/07 % OF TOTAL FUNDER TOTALVS. PROGRAM SPECIFIC FUNDER REQUEST BUDGET BUDGET (col. B/col. A) EXPENDITURES 21 Salaries 161 ,521 .00 32,200.0019 .94% 22 FICA 12,356. 00 2,463 .30 19. 94% 23 Retirement 63508.82 1 ,750.00 26.89% 24 Life/Health 10 ,895.40 21400.00 22 .03% 25 Workers Compensation 5,463.78 836 .21 15. 30% 26 Florida Unemployment 577.80 0.00 0.00% 27 Travel-Daily12,636.00 0.00 0 .00% 28 Travel/Conferences/Training21174.88 0.00 0.00% 29 Office Supplies 5,438.00 750.00 13 .79% 30 Telephone 89604. 00 0. 00 0.00% 31 Postage/Shipping 21214.40 0.00 0.00% 32 Utilities 81400.00 0.00 0 .00% 33 Occupancy (Building & Grounds 23,676 .00 5, 180.97 21 .88% 34 Printing & Publications 31739 .92 0 .00 0.00% 35 Subscription/Dues/Memberships 381 .48 0.00 0.00% 36 Insurance 43038. 12 19500.00 37. 15% 37 Equipment: Rental & Maintenance 71164.00 0.00 0 .00% 38 Advertising25356.24 0.00 0. 00% 39 Equipment Purchases: Capital Expense 49000.00 0.00 0.00% 40 Professional Fees (Legal, Consulting) 0.00 0.00 #DIV/01 41 Books/Educational Materials 1 , 108. 16 0.00 0.00% 42 Food & Nutrition 0.00 0.00 #DIV/0 ! 43 Administrative Costs 41 ,297.00 0. 00 0.00% 44 Audit Expense 978.801 0.001 0. 00% 45 Specific Assistance to Individuals 920.00 0.00 0 .00% 46 Other/Miscellaneous 418.48 0.00 0. 00% 47 Other/Contract 2, 500.00 0.00 0 .00% 48 TOTAL $329,368.28 $475080.48 14.29% 51222005 a-0 21 h+nu• cme cxsnE UNIFORM GRANT APPLICATION EXPLANATION FOR VARIANCES OF 15% OR MORE TOTAL PROGRAM BUDGET AGENCY/PROGRAM NAME: EXCHANGE CLUB CASTLE / SAFE FAMILIES FUNDER: Children's Services Advisory Committee L1NE{TEbF nQFJtPLANATR-SNTOS:1[AR1AyCE #DIV/O! #DIVIOI #DIVral #DIV/01 De artment of Children 8 Families Under-budgeted last ear. UFF funds to increase IRC services. #131 10! Contributions-Cash Results from new development staff. #DMO! Fund Raising Events-Net New fundraising events in Indian River Count #DIVIO! #Dlmel #DIV101 #DIV/01 #DIV101 Funds from Other Sources Increasing re uesls from foundationslcorporations #DIVI01 #DIV10t Salaries Addition of arent educationrcounselor1communitv relations Staff FICA Increases with salary Life/Health Additional employees or top for benefts/increase in rates Workers Compensation Increase in rate for workers comp. Travel-Dail Additional staff, increase in mileage rate, more north county referrals. Office Supplies Additional em loyees supplies Telephone Additional employees in program Utilities In newfacilily - have solid projections of annualized costs Occupancy (Building 8 Grounds In newfacilit - have solid pro actions of annualized costs Insurance Increase in insurance rates-liabilit / mnram gmwlh E ui mentRental 8 Maintenance Equipment for new facili , W ier, fax, phones Advertisin Additional advernsin in communi4 ,1---- Equipment y/commE ui ment Purchases:Ca hal Ex ense U date com uters, equipment for network, web page #DIV/01 BookslEducational Materials Update books and materials #DIV/OI Administrative Costs 14% of bud at OtherlMiscellaneous AddAional background checks on employees OtherlContract Contracts for computer repair/maintenance 22 t �m (L., CASTLE WeF,m,.. X6 M, UNIFORM GRANT APPLICATION EXPLANATION FOR VARIANCES OF 15% OR MORE FUNDER SPECIFIC BUDGET AGENCY/PROGRAM NAME: Exchange Club CASTLE I Safe Families FUNDER: Children's Services Advisory Committee - Indian River County - - - - --E'FTEbf " ". it _. . . _ ._. . _ 'iIT v-. _ _,.EEXKANATJON FQR .VARIANCE Salaries Increase in match requirement to match UFF funds FICA Increase in match requirement to match UFF funds Retirement Additional staff eligible for Benefits LifeMealth Additional staff eligible for BenefitWiincreese in rates Workers Com enation Increase in Workers comp rale Occupancy (Building & Grounds Increase in rent for offices and maintenance of buildingslActual expense of new building. Last year were projections. Insurance Increase in insurance rates #DIvf01 #DIVIoI 23 as Appendix 24 Organization: Exchange Club CASTLE Program Name Safe Families References ' US Department of Health and Human Services: The Administration for Children and Families, Prevention Pays: The Costs of Not Preventing Child Abuse and Neglect April 1999. " US Department of Health and Human Services: The Administration for Children and Families, Child Maltreatment, 2000. '° Harder, Jeanette; An Evaluation of a Home Visitation Parent Aide Program Using Recidivism Data; 2005 . CPS Child Watch, Child Abuse Statistics, January 6, 2003 Florida Abuse Hotline Information System, Child Protective Investigations Report Type for Reports Received; Fiscal Year 2004-2005 . Thomas, David, et. al, Emerging Practices in the Prevention of Child abuse and Neglect; Department of Health and Human Services, Washington DC2001 . " Center for Disease Control and Prevention Task Force : First Reports Evaluating the Effectiveness of Strategies for Preventing Violence (a meta-analysis of 25 studies), 2003 . "'° Guterman, Neil, Stopping Child Abuse Before it Starts, Sage Publications, CA, 2001 . " U. S. Department of Health and Human Services, Report on Child Abuse and Neglect, 2002 . x U. S. Department of Health and Human Services, April 2003, vol. 4, no. 3. Benefits and Costs of Prevention and Early Intervention Programs for Youth; Washington State Institute for Public Policy, Olympia, WA, 2004. See reference iii. 25 �U ASSESSMENTS Client : File #: open: Close: Counselor: FAMILY RISK/PROTECTIVE FACTORS Instructions: When a hsklprotective factor is assessed, place a checkmark in the box if the factor needs to be addressed. Upon completion (a risk factor that is no longer a risk, or a protective factor that has been enhanced) write, 'completed" in the appropriate box. (if a risk/protective factor does not need to be addressed, the box will be blank) RISK FACTOR INITIAL 3 MONTH 6 MONTH 9 MONTH ASSESS. AT ASSESS. DATE: ASSESS. DATE: ASSESS. DATE: ASSESS. DATE: COMPLETION 1. Additional parenting knowledge/ skills needed 2. Parents history of abuse as a child 3. Parent/s history of substance abuse 4. Parent/s history ofinental health issues 5. Domestic Violence — Past/Present (Victim/Per etrator) 6. Inability to meet basic needs 7. Teen, young or non-traditional arent 8. Lack of support system 9. Parents/Children with physical handicaps or other diagnosable conditions 10. Other PROTECTIVE FACTOR INITIAL 3 MONTH 6 MONTH 9 MONTH ASSESS. AT ASSESS. DATE: ASSESS. DATE: ASSESS. DATE: ASSESS. DATE: COMPLETION LHousing stability 2. Delay 2f subsequent pregnancy 3. Enrollment in childcare 4. Enrollmentin healthcare 5. Child receives routine medical care 6. Livable wage employment 7. Active participation in child's school 8. Positive Family Communication 9. Constructive use oftime 10. Supportive adults outside ojfamily AAPISCORES AAPI-A (Pre) AAPI-B (Post) A B C D E A B C D E A B C D E A B C D E Word/S/SF Forms/Family Risk/Protective Factors Assessment Form/Rev. 02/05 26 Adult-Adolescent Parenting Inventory AAPI - 2 Form B Stephen /. Bauo%k, Ph,D. and Richatd6 Keene, Ph. D, Name Date ID# State/City Sex (circle one) Male Female Age years Race (circle one) White Black Asian Hispanic Native American Pacific Islander Other INSTRUCTIONS: There are 40 statements in this booklet. They are statements about parenting and raising children. You decide the degree to which you agree or disagree with each statement by circling one of the responses. STRONGLY AGREE — Circle SA if you strongly support the statement, or feel the statement is true most or all the time. AGREE — Circle A if you support the statement , or feel this statement is true some of the time. STRONGLY DISAGREE — Circle SD if you feel strongly against the statement or feel the statement is not true. DISAGREE — Circle D if you feel you cannot support the statement or [twat the statement is not true some of the time. UNCERTAIN — Circle U only when it is impossible to decide on one of the other choices, When you are told to turn the page, begin with Number 1 and go on until you finish all the statements. In answering them , please keep these four points in mind: 1 . Respond to the statements truthfully. There is no advantage in giving an untrue response because you think it is the right thing to say. There really is no right or wrong answer — only your opinion. 2. Respond to the statements as quickly as you can. Give the first natural response that comes to mind. 3. Circle only one response for each statement. 4. Although some statements may seem much like others, no two statements are exactly alike. Make sure you respond to every statement. If there is anything you don't understand , please ask your questions now. If you come across a word you don't know while responding to a statement, ask the examiner for help When you finish, please feel free to write any comments you have on the back page. Turn the Page and Begin '1999 Family Development Resources, Inc. All rights reserved. This test or parts thereof may not be reproduced in any form without permission of the publisher. (800) 688-5822 (435) 649-9599 (fax) • mc9familydev.com (email) arnnv.n urtu ringparenting.com AATB-2 1-99 27 Form B Strongly Strongly Agree Agree Uncertain Disagree Disagree 1 . Children who express their opinions usually make things worse. SA A U D SD 2 . The problem with kids today is that parents give them too SA A U D SD much freedom. 3 . Children should offer comfort when their parents are sad. SA A U D SD 4. Children who learn to recognize feelings in others are more SA A U D SD successful in life. 5 . Spanking children when they misbehave teaches them how to SA A U D SD behave. 6. Children who bite others need to be bitten to teach them what SA A U D SD it feels like . 7. Children need to be potty trained as soon as they are two SA A U D SD years old. 8. Parents who are sensitive to their children 's feelings and SA A U D SD moods often spoil them. 9. Crying is a sign of weakness in boys. SA A U D SD 10 . Children should be obedient to authority figures. SA A U D SD 11 . You cannot teach children respect by spanking them. SA A U D SD 12. Children learn violence from their parents. SA A U D SD 13. Parents' needs are more important than children 's needs. SA A U D SD 14. Praising children is a good way to build their self-esteem. SA A U D SD 15. Children nowadays have it too easy. SA A U D SD 16. Children should be the main source of comfort for their SA A U D SD parents. 17. Parents expectations of their children should be high but SA A U D SD appropriate. 18. Children who are spanked usually feel resentful towards their SA A U D SD parents. 19. Strong-willed toddlers need to be spanked to get them to SA A U D SD behave. Please go to next page. ©1999 Family Development Resources, Inc. NI Rights Reserved. t-ss This test or parts thereof may not be reproduced in any form w.thcut permission of the publisher. 28 AA-1 f-2 Form B Strongly Strongly Agree Agree Uncertain Disagree Disagree 20. Children should be seen and not heard. SA A U D SD 21 . Parents who encourage their children to talk to them only end SA A U D SD up listening to complaints. 22 . Give children an inch and they'll take a mile. SA A U D SO 23 . Parents spoil babies by picking them up when they cry. SA A U D SD 24 . Children should be considerate of their parents ' needs. SA A U D SD 25 . In father 's absence, the son needs to become the man of the SA A U D SD house. 26. Consequences are necessary for family rules to have meaning . SA A U D SO 27. Children should be taught to obey their parents at all times. SA -A U D SD 28. Mild spankings can begin between 15 to 18 months of age. SA A U D SO 29. If a child is old enough to defy a parent, then he or she is old SA A U D SD enough to be spanked. 30. The less children know, the better off they are. SA A U D SO 31 . Two year old children make a terrible mess of everything. SA A U D SD 32. If you love your children , you will spank them when they SA A U D SO misbehave. 33 . Parents should expect more from boys than girls. SA A U D SO 34. Older children should be responsible for the care of their SA A U D SD younger brothers and sisters. 35. Rewarding children 's appropriate behavior is a good form of SA A U D SD discipline. 36. Never hit a child, SA A U D SO 37. Children who are spanked behave better than children who are SA A U D SD not spanked. 38. Children should know when their parents are tired. SA A U D SO 39, Good children always obey their parents. SA A U D SD 40. Children cry just to get attention. SA A U D SD ©1999 Family Development Resources, Inc. All Rights Reserved. t 99 This test or parts thereof may not be reproduced in any form •Nithout permission of the publisher. - ,AAT&2 29 ® � �. ��®®®� �"""'�®®®off ""'®®®®v "..®,,...�®®off a / 1 • • / ,: ,. - . . 9a a �. w� vxf.yT'�5}1 �l,�rt411 g`..tl �idk rfl ; 1s ar7 rN pra ! �t p s ° a� rN' t'G^J � r ! 't 3 ae•} r i5 Iri iia` a ! r "ft.y > 7 j"� :. `ur M p+ • ' J t + A', �,M`�at-t,�Jc4a4!'>eF J s h ! � # i ��A *AY r w 'p#k,S w � - I. flr 1• A 9 A �S1�t �'wt �..rrrar.Pk!M�4rr` '� h� 5 ` 4� ! r(�ry>��Ac � Y f 4�F�'� `�. µ • . Y 5* eya'Ylfv 7f` IuY i r � 4ra Ya s d:ye,'�t S lr tf Y t+ 1 +n r e 4l ai t N Ixld.,r�irtrw T !'u l4lF�+.�D'F"!14 N� '�a, Pk '1 k � Aa A I f ry t ' SV !1611 I � t y a nar9 ^y` ! � d t .� �t��"' Nt.u�pl+vCt�,t1 ,lah�J,c4luimdl.i7�Yz+.kHYi+u la ! � r � : e a � + 1 S! 1tY at iY � ry'rv'a�/ Ae a ku�^',u�,��r li , 1' r i ' <'' aj 3,� 1f t r /y � � f � 11.&5, yl.. y r-7l� >�uSu f t�tuf}n�^L4' ?I�Ht9',3y,_ "C. 4y�hY.�i�� E.Ta�� +r0� wl I C«�Iu P I ! 1 rZ � �tr 71 h '�r °� ,. p��p i �'a.* 4r lA kT�� nt � " r 'r"'3l jy ! 4yyn uv +L, 11 S&k al.a J R uc.1s J 1 vC�l . +� Or^ l >p IA y 1 t t i !C rl 4f tu6r. W I L L �LI iCa (+ .11V1 t N. F . .� �. �. L� 1 �f°. -, l V 1 �} 1 d. .; ..i : � U � r. nq • • 1 1 : 1 1 1 1• 1 1� ; 1 1 1 1 u P l tl 4 I' f • � _ 5 1 � 1 1' EXHIBIT B (From policy adopted by Indian River County Board of county Commissioners on February 19 , 2002) " D. Nonprofit Agency Responsibilities After Award Funding Indian River County provides funding to all nonprofit agencies on a reimbursement basis only . All reimbursable expenses must be documented by an invoice and/or a copy of the canceled check. Any expense not documented properly to the satisfaction of the Office of Management & Budget and/or the County Administrator may not be reimbursed . If an agency repeatedly fails to provide adequate documentation , this may be reported to the Board of Commissioners . In the event an agency provides inadequate documentation on a consistent basis, funding may be discontinued immediately. Additionally, this may adversely affect future funding requests . Expenditures may only be reimbursed from the fiscal year for which funding was awarded . For example, no expenditures prior to October 1s` 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 301") 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 184025 th Street Vero Beach , Florida 32960-3365 Recipient: Exchange Club Castle P .O . Box 12908 Fort Pierce, Florida 34979 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 - WpU- e2-2W6 V15 ; 09 - VVHRRFi'1R INS FPy..`•• '., ~y V.•~ - �y 17724E412315 LP. 01 A ORD CERTIFICATE OF LIABILITY INSURANCE OHIO '7 �xOA ' "o" RRptt)tpL TN15 CERTIFICATE IS ISSUFIAS A MATTER C'F INFORMATION ONLY AND CONFERS NO RIFHYS UPON THE 0FRT(FICATE YAABOR SNSTJRANCB AGENCY HOLDER. THIS CERTIFICATE' DOES NOT ANTRIM EXTEND OR 2272 . Coloaial Road , Suite 300 ALTERTHE COVERAGE AFFORDED BY THE POLICIES BELOW. Fort Pierce FL 34950 - 5309 Phone-% 772 - 461-604D , Fax : 772 . 4604315 INSURERS AFFORDING CCVEPAGE � NIUCa INSVREO , wp1RER A: Fna1W�ile SnMM .RY ieR co The Bxehas;<18 Cjt3b Canter ....—. N EO Lha P1'dven Ion Of Qpktl Abuse DBA WSUR£R t: 89:chaaga Club C . A . E . T . L . E . -- Po Boz 12900 INWRER O: .. .-_. Ft Pierce SL 34979 -" INSURER E' _ COVERAGES _ Tr.EPOUCIL.S OF IKWAANCE LISTED FIELOW --IAVE PEEN ISSUED TO IHE INSURED AAMSO ABOVE VCR 'HE POLICYFERI02 INDICATED. NOTVrI'11STANDIIIf ,VH RE2UIRENIENT. TERM OR CONDITION OF ANT OpNTRAOT OR OTHER OCCUMEN ' .NTN RESPECT TO WHICH YHIS OERTIF ICATE W Y BB IR'UQD OR MAY PSRTAIN. THE INSURANCE APr ORO60 BYTHE POUCIEE OESCP.iOEO HEREIN R aRU:-CT TO ALL T iE TERNS EXCLUSIONS WOO' )NC TONS of $UCII PDL �CIE3 AflOX60ATE L:MITS SHO WV MAT 'H0.a'E EFFN REDUCED EY PAID OWNS_ INSR%OO '--- -• - } .011x?E"fFFt'NP FOLlC7eY WIRAT) f _ ulLlTs LTR INS 'YPE OF iNSORANCS IROLICYNUIdpBA ` DATE tMN/OOIW) OA (MMIDC/Tyl – aENEFwLUAsiU+'+' EACHOODURR6NC:1 31 , 000 . 000 armimmi — A X ,.. X , CCVK'RCuLGENEAALLIABaI'Y , FRPY163569 03 / 26 /06 ' 03 /26 /07 LPN.Mb=a !a+ xa+I., Ka _ 5100 , DD0 '!' CiAIA1S MAq"- 117J OCCJR MED EXP (A,� OM DeISOrI ! $ OOO_ iPERSON AADVIIIJJR { 1 , 000 , DOO T IF0lNGRAL apORE T( 53 000 C00 IPROpUC . S . eoeIIPCP A,=G 33 , 000 , 000. AGGREGLTESLIpM�B ? POUOY U DTLOC 1 d R UUIOMON I(L£ WeIJ1T I CONtlIN0031NOLE . UR S > ALLOWNEDAUTOS l QNLYI .NRY s . I W.HEOULED A'JTOS I arrdimCe`RY -_ � . j_.3 HIREDAU703 I NOKOVAKED AUTOS - I -I Ef:f w - I PROP;RTY DAMAGE _.• •. Y I � (aEr Bcc�Mnq � ' riELLr '. ` Ga�^—{—RAG -- AUTO 0N�z._EA n[ [ IDEN '_ . i ._ . . . - ,.�!ti -`.. � ANYAUYO I OTHE9 THAN rAJ ;C 3 , ,• ,J3 ^.'ti^, — AUTO ONLY: = y { EKCISSARNNFFLI.A W/1UN EAG/ OCCURRENCE 3 . .. .__ DOWN C:1.iMD MADE ACGREGA_E 1 I ,I .. NBTIN JOS S rr .. . . A'twps OCIMM A7R)N AND TORY'_IMIT$ JSf��R, l•_„_- ...� BMKC'%FR7' I AndJTL' 6.LrSACN ACCIDlP7 t Y pN�'FROPRIETDR+PARLNENEN€CLTNE . l.L. pSGABL • EA IN move 3 — 1� OFFVAARAEMQER EXCLUDED? IFVR -G+aieN :new E.L. DISEASE - PVL CYLINIT I3 :.'. L 'SREC�IM PROVSIONS BNPM _�!—___. . . OTHER Fretfiasiomal Liab , P8PX163969 03 / 26 / 06 ' C3 / 26 / 07 OogT3t'zelDc c51 , 000 , 000 A � Seicual Phy Abuse PRPK163965 03 / 26! 06 03 / 2fi / 07_ ! reC _ , to ; 2000 . 000 DEA'.RldTION OF ORERATIONB! LOCATIONS IVFNICLFif E%CLVSIONa t4fin ENDORSEMENTr WL PR --*�.lA _daye zon-payment of pre341um . Ci'tifieaea Folder is named as an i� 3Ed'd'i°t zonal 1ronred . for General Liability coverage . -PTIFICATEHOLDER CIWCELLATION _ A INDIA - 3 SHWM D ANT OF 111E ASOLIa CESCASMO FOUCIEB SE G4ICElL6O Be”; QMRRTIgw� ' Ol1TF TNERFAF THE Ri3VING NSpFiFR 1L11LL Fjg3AVOR 7D NWL 308 BAK WRITTEN Indian River County IroT1cETorNB CBRnFI.:A'B MOWN ENae¢a TO TrIE UN7, BUT Fa LNRE To 00 so 51V1LL. Attn : Narion Naetersoa )N/O5E NO OBLIGATION oe LIABRIT ' OP ANY FUND W014 FINE INWItiN, RV AOBNTE OR 1840 25th Street RcnX55u3raTrvEa .. ` Vero Beacb FL 32960 e IdL 6 aarwgnraDR£rAesENTATIVE . } — Cindy McCall � .A 1 RQZS (2007108) F UORD 1968 1 " jrJT. IARBOR INSURANCE AGENCY MEMO Page 1 y 2222 Colonial Road, Suite 100 Fort Pierce, FL 34950-5309 EXCHA-1 :, LW 04/18/2006 Phone: 772-461-6040 Fax: 772-460-2315 f+++ PB PK163969 PCKG 03/26/2006 03/26/2007 The Exchange Club Center Exchange C.A.S.T.L.E. PO Box 12908 Ft Pierce, FL 34979 Attached is a list of holders which were sent certificates on your renewal policy term . If you should need additional certificates in the coming year , please call our office with the complete name and address , fax number , if necessary . i Thank you . Liane Walker C .. E R T IFI CATE HOLDER LI ST Date 04 / 18 / 06 . . . . . . . . . . . . . . . . . . . . . . . . 0 . . . . . . . . . . . . . . . . . Page 1 Customer : EXCHA - 1 Range : All Dates : All Ce Exchange Club Center Code Name Street City ST Zip Code Iss Date Queued Days . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Copyco Inc . P . O . Box 3083 Cedar Rapids IA 52406-3063 04/18/06 No 10 Department of Children 337 North 4th Street Ste A Ft . Pierce FL 34950 04 /18 /06 No 10 and Families Attn : Ann Birnes Junior League of P . O . Box 3008 Vero Beach FL 32964 04 /18/06 No 10 Indian River Inc . North South Plaza, Inc . 686 3rd Place Vero Beach FL 34962 04 /18 /06 No 10 Publix-St . Lucie West 1333 NW St . Lucie Blvd . Pt . St . Lucie FL 34966 04 /18/06 No 10 Fax : 465-6013 Ted Glasurd Associates , Inc . 461 S . 7th St . , #2470 Minneapolis MN 55415 04/18/06 No 10 Fax : 465-6013 Ken Hallman United for Families P . O . Box 2399 Fort Pierce FL 34954 04 /18/06 No 10 Fax #772-398-2925 CHILD-1 Childrens Service Council of 2030 SE Ocean Blvd . Stuart FL 34996 04 /18 /06 No 10 Martin County Fax 772-288-5799 Attn : Frances Description of Operations Certificate Holder is an additional insured for general liability . CHILD- 1 Childrens Service Council of 250 NW Country Club Dr , Ste240 Pt St Lucie FL 34986 04/18 /06 No 10 St Lucie County Fax : 464-2134 H&HLL- 1 H & H, LLC 800 Virginia Avenue, #38 Fort Pierce FL 34982 04/18 /06 No 10 Description of Operations H & H, LLC, as Landlord, and Additional Insured, is included as an Additional Insured as respects General Liability for location at 800 Virginia Avenue , Unit #34 & 35 , Fort Pierce, FL 34982 . HARBO- 1 Harbor Federal Savings Bank P O Box 249 Ft Pierce FL 34954 04/18/06 No 10 Its Successors and/or Assigns ATIMA Description of Cperations Be : Loan #52-24545650; Property Address : 3525 W . Midway Road, Fort Pierce . INDIA-2 Indian River Co Building Dept 1840 25th Street Vero Beach FL 32960 04 /18/06 No 30* Fax : 772-770-5333 Attn : Linda Jones Description of Operations *10 days nonpayment of premium . INDIA-2 Indian River County 1840 25th Street Vero Beach FL 32960 04 /18/06 No 30* Description of Operations *10 days non-payment of premium . Certificate Holder is named as an Additional Insured for General Liability coverage . INFOR- 1 For Information Purposes Only 04/18 /06 No 10 MARTI- 6 Martin County Chamber of 1650 S Canner Hwy Stuart FL 34994 04/18/06 No 10 / Commerce (` Description of Operations Chamber Expo Philadelphia Insurance Companies One Bala Plaza, Suite 100, Bala Cynwyd, Pennsylvania 19004 Philadelphia Indemnity Insurance Company COMMON POLICY DECLARATIONS Policy Number: PHPK163969 Named Insured and Mailing Address : Producer: 1365 The Exchange Club Center for the HARBOR INSURANCE AGENCY Prevention of Child Abuse 2222 COLONIAL ROAD PO Box 12908 SUITE 100 Fort Pierce , FL 34979- 2908 FORT PIERCE, FL, 34950 Policy Period From : 03/26/2006 To: 03/26/2007 at 12:01 A.M. Standard Time at your mailing address shown above. Business Description : Non Profit Organization IN RETURN FOR THE PAYMENT OF THE PREMIUM , AND SUBJECT TO ALL THE TERMS OF THIS POLICY, WE AGREE WITH YOU TO PROVIDE THE INSURANCE AS STATED IN THIS POLICY. THIS POLICY CONSISTS OF THE FOLLOWING COVERAGE PARTS FOR WHICH A PREMIUM IS INDICATED. THIS PREMIUM MAY BE SUBJECT TO ADJUSTMENT. PREMIUM Commercial Property Coverage Part 8,487. 48 ( Commercial General Liability Coverage Part 31698. 00 Commercial Crime Coverage Part 513 .00 Commercial Inland Marine Coverage Part 11348. 00 Commercial Auto Coverage Part Businessowners Workers Compensation Employee Benefits 300. 00 Professional Liability 51336 . 00 Sexual/Physical Abuse INCLUDED Total $ 19,682.48 Total Includes Fees and Surcharges (See Schedule Attached) 12.48 Total Includes Federal Terrorism Risk Insurance Act Coverage 76. 00 FORM (S) AND ENDORSEMENT (S) MADE A PART OF THIS POLICY AT THE TIME OF ISSUE Refer To Forms Schedule 'Omits applicable Forms and Endorsements if shown in specific Coverage Part/Coverage Form Declarations I Countersignature Date Authorized Representative luto- Owners Page 1 19020 ( 10 - 80 ) 17" Issued 01 - 03 - 2006 INSURANCE COMPANY AUTOMOBILE POLICY DECLARATIONS 6101 ANACAPRI BLVD . , LANSING , MI 48917 - 3999 AGENCY FLOWERS - YATES INSURANCE INC Renewal Effective 02 - 17 - 2006 12 - 0172 - 00 MKT TERR 051 ( 772 ) 461 - 3171 POLICY NUMBER 42- 209 - 850 - 00 INSURED EXCHANGE CLUB CASTLE Company Use 20 - 04 - FL - 0002 Company POLICY TERM ADDgEss PD BOX 12908 Bill 12 : 01 a . m . 12 : 01 a . m . FORT PIERCE FL 34979 - 2908 to 02 - 17 - 2006 02 - 17 - 2007 In consideration of payment of the premium shown below , this policy is renewed . Please attach this Declarations and attachments to your policy . If you have any questions , please consult with your agent . DESCRIPTION OF ITEM INSURED AGE SYMBOL/COST TERRITORY CLASS/PG Comprehensive Liability - 027 SPL St Lucie County , FL COVERAGES LIMITS PREMIUM Combined Liability $ 500 , 000 occurrence $ 123 . 99 FOREIGN TERRORISM - CERTIFIED ACTS SEE FORM 59350 1 . 24 TOTAL $ 125 . 23 Additional Forms For This Item : 79547 ( 03 - 99 ) 79539 ( 03 - 99 ) PREMIUM BASIS : Estimated cost of hire - liability $ If Any ( Subject to audit ) 140 1 . 1999 FORD WINDSTAR 8 027 8CA VIN : 2FMZA5147XBB03813 St Lucie County , FL COVERAGES LIMITS PREMIUM Combined Liability $ 500 , 000 occurrence $ 943 . 00 Uninsured Motorist $ 500 , 000 person/$ 500 , 000 occurrence 181 . 00 Medical Payments $ 10 , 000 person 18 . 00 Personal Injury Protection $ 10 , 000 34 . 00 Comprehensive Actual Cash Value - $ 500 deductible 103 . 00 Collision Actual Cash Value - $ 500 deductible 230 . 00 Additional Expense $ 40 /Day , $ 1200 Maximum 60 . 00 FOREIGN TERRORISM - CERTIFIED ACTS SEE FORM 59350 15 . 69 TOTAL $ 1 , 584 . 69 Interested Parties : None Additional Forms For This Item : 79255 ( 12 - 01 ) 79308 ( 01 - 01 ) 79402 ( 07 - 94 ) 79537 ( 06 - 92 ) 79539 ( 03 - 99 ) 79939 ( 03 - OS ) PREMIUM BASIS : Radius of operation - within a 100 mile radius . USE CLASS ( 00552 ) : NOC Not Wholesale Or Retail Delivery . 140 0020500 LN-e CASTLE OUR MISSION IS TO IMPROVE THE QUALITY OF FAMILY LIFE AND PREVENT CHILD ABUSE AND NEGLECT BY PROVIDING COMMUNITY EDUCATION, SUPPORT AND RESOURCES FOR PARENTS IN NEED OF ASSISTANCE. The CASTLE does not use an agency vehicle to transport clients . Doug Bo 1 Assistant Dire r op000e 25 YEARS OF SERVICE AS THE PARENTING PROFESSIONALS OF THE TREASURE COAST LS_ OREECHOBEE Cri ST. LUCIE COUNTY MARTIN COUNTY INDIAN RIVER COUNTY MAILING ADDRESS 3525 S.W. M]D Ay ROAD 3814 S.E . Dixie Hwy. 1275 OLD DIXIE Hwy. PO. Box 12908 FORT PIERCE, FL 34981 SR,AET, FL 34997 Veno BEACH, FL 32960 FORT PIERCE, FL 34979 P: 772-465-6011 P: 772-781 -4510 P: 772-567-5700 F: 772-465-6013 F: 772-219-0791 F: 772-567-7133 WWW. SXCHANGECASTLE . ORG The CASTLE is sponsored in part by the State of Horicia and the Department of Children & Families, United Way of Indian River, Martin, St, Lucie and Okeechobee Counties, Children's Services Councils ofmorBn and St. Lucie Counties, Children's Services Advisory Committee of Indian River County, United for rumities, Safe Havens - Office of Violence Against W omen, I.. League of Indian River County, and Exchange Clubs. F A FLORIDA WORKERS COMPENSATION JOINT UNDERWW14G ASSOCIATION, INC. WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY TYPE AR INFORMATION PAGE WC 00 00 01 ( A) POLICY NUMBER : ( 6FR13UB - 2817C61 -8 - 05 ) NEW- 05 INSURER: FLORIDA W . C . JUA t NCCI CO CODE: 80179 INSURED : EXCHANGE CLUB CENTER FOR THE HARBOR INSURANCE AGENCY PREVENTION OF CHILD ABUSE OF "N�F1L1ATEO HARBOR FEOFRAC SWNL MNK PO BOX 112908 2222 Colonial Pocd • Suite 100 Fort Pierce, FL 34950-5309 FT PIERCE FL 34979 772-461 -6040 FAX 772-460-2315 harborio . com Insured is A CORPORATION Elm I Other workplaces and identification numbers are shown in the schedule(s) attached . 2. The policy period is from 12 -06 - 05 to 12 -06 -06 12 :01 A. M . at the insured 's mailing address. 3. A. WORKERS COMPENSATION INSURANCE: Part One of the policy applies to the Workers Compensation Law of the state(s) listed here: FL B . EMPLOYERS LIABILITY INSURANCE: Part Two of the policy applies to work in each state listed in item 3.A. The limits of our liability under Part Two are: Bodily Injury by Accident: $ 500000 Each Accident Bodily Injury by Disease: $ 500000 Policy Limit Bodily Injury by Disease: $ 500000 Each Employee C. OTHER STATES INSURANCE : Part Three of the policy applies to the states, if any, listed here: SEE ENDORSEMENT FWCJUA 03 01 D. This policy includes these endorsements and schedules : SEE LISTING OF ENDORSEMENTS - EXTENSION OF INFO PAGE 4. The premium for this policy will be determined by our Manuals of Rules , Classifications, Rates and Rating Pians. All required information is subject to verification and change by audit to be made ANNUALLY . DATE OF ISSUE: 01 - 06-06 HS ST ASSIGN : FL OFFICE: FLORIDA WC JUA 821 PRODUCER : HARBOR INSURANCE AGCY 23B9J x161 as FWC FLORIDA WORKERS ' COMPENSATION JOINT UNDERWRITING ASSOCIATION , INC . P. O. Box 48957, Sarasota, FL 34230-5957 Tel (941 ) 378-7400 Fax (941 ) 378-7406 12/ 19/2005 App # : 72570 Effective Date : 12/06/2005 Binder Number : 2817C618 EXCHANGE CLUB CENTER FOR THE PREVENTION OF CHILD ABUSE OF THE TREASURE COAST IN PO BOX 12908 FORT PIERCE FL 34979 RE : WORKERS COMPENSATION AND EMPLOYERS LIABILITY BINDER. This is to acknowledge receipt of an estimated or deposit premium payment and your application for coverage through the Florida Workers' Compensation Joint Underwriting Association , Inc. ( FWCJUA) . The FWCJUA is providing coverage under this binder for 30 days, beginning at 12 : 01 a . m . on the effective date shown above. Coverage is provided under the Workers' Compensation Law of Florida only. Employers Liability coverage is also provided subject to the following standard limits : Bodily Injury By Accident : $ 100, 000 - each accident Bodily Injury By Disease : $ 500 , 000 - policy limit Bodily Injury By Disease : $ 100, 000 - each employee If additional limits were requested, those limits are detailed on the following page . The policy issued will be written in the name of the Florida Workers Compensation Joint Underwriting Association , Inc. and services will be provided by the company listed below . Please retain this binder as evidence of coverage until you receive your policy. COMPANY: TRAVELERS P. O . Box 3556 Orlando FL 32802 (800 ) 247-7218 AGENCY: CINDY MCCALL HAYNES & HAYNES INSURANCE 2222 COLONIAL ROAD SUITE 100 FORT PIERCE FL 34950- 5309 (772) 461 - 6040 2817C618172570 1 FWC FWCJUA Premium Calculation This premium calculation is ESTIMATED based upon information presented. { - EXCHANGE CLUB CENTER FOR THE PREVENTION OF CHILD ABUSE OF THE TREASURE COAST INC DBA EXCHANGE CLUB CASTLE Tier 3 Effective Date : 12/06/2005 Governing Class - 8861 Increased Limits - soo/soo/soo (See Page Two for Officer Information) Class Code Employees Payroll Rate Premium 8861 CHARITABLE OR WELFARE ORGANIZATION 49 $ 810,000 .00 1 .68 $ 13,608 9110 CHARITABLE OR WELFARE ORG.-ALL OTHER o $ 0.00 9 . 38 $0 Officers Total Payroll $ 0 $0 $0 Employees Total Payroll $810,000 $ 13,608 $ 13,608 Voluntary Market Terrorism Surcharge 0. 03 $243.00 Increased Limits Factor 0.80 $ 109 Experience Modification 0.92 $- 1 ,097 Risk Adjustment Program Surcharge Factor 1 . 00 $0 JUA Surcharge 1 . 70 $ 0 $22,207 Plus Expense Constant $200 Assigned Risk Flat Fee $475 Total Estimated Annual Premium $35,745 Advanced Premium Required 0. 50 1 ,000 Minimum 17, 872 Deposit Required 0.50 $6500 0 Total Down Payment Required 17r872 Actual Deposit $ 19,354. 00 Sufficient Additional Premium Due $ 0. 00 Printed : 12/15/2005 4 : 47 : 12PM Assignment Additional Notice Notice COVERAGE FOR THIS EMPLOYER HAS BEEN PLACED THROUGH THE FLORIDA WORKERS ' COMPENSATION JOINT UNDERWRITING ASSOCIATION , INC. ( FWCJUA) . AS THE FWCJUA IS THE MARKET OF LAST RESORT, COVERAGE SHOULD CONTINUE TO BE SOUGHT THROUGH THE STANDARD/VOLUNTARY MARKET. PLEASE NOTE THAT PREMIUMS IN THE FWCJUA MAY BE HIGHER THAN THE STANDARD/VOLUNTARY MARKET AND THIS EMPLOYER MAY BE SUBJECT TO FUTURE ASSESSMENTS . IF AN OFFER OF COVERAGE IS OBTAINED FROM A VOLUNTARY MARKET INSURER, GROUP SELF-INSURERS ' FUND, COMMERCIAL SELF-INSURANCE FUND, OR AN ASSESSABLE MUTUAL INSURER, THIS EMPLOYER IS NO LONGER ELIGIBLE FOR COVERAGE THROUGH THE FWCJUA . ACCEPTANCE OF COVERAGE THROUGH THE FWCJUA BY AN EMLOYER CREATES A CONCLUSIVE PRESUMPTION THAT THE EMPLOYER IS AWARE OF THIS POTENTIAL. EMPLOYER: SINCE YOU HAVE BEEN UNABLE TO SECURE WORKERS ' COMPENSATION INSURANCE THROUGH ANY OTHER INSURANCE PROVIDER, YOUR COVERAGE IS BEING OFFERED THROUGH THE FLORIDA WORKERS ' COMPENSATION JOINT UNDERWRITING ASSOCIATION (FWCJUA) AND YOUR PREMIUM IS SURCHARGED . If a policy issued, pursuant to an assignment under the FWCJUA, is cancelled due to the employer's failure to comply with terms or conditions of the policy, such employer may be ineligible for further coverage under the FWCJUA. 1 Service Provider: Form UCT-6 or its equivalent is attached . . 2 Service Provider: A list of all employees for this employer is attached . 3 Service Provider: Experience Rating Worksheet is attached . 4 ERM- 14 is attached 5 Service Provider: Applicant's Affidavit is attached . 6 Service Provider: Employment and Wage Information Release Agreement attached. 7 Employer: Since you have been unable to secure workers' compensation insurance through any other insurance provider, your coverage is being afforded by the Florida Workers Compensation Joint Underwriting Association ( FWCJUA) and your premium is surcharged . 8 The FWCJUA does provide limited coverage for exposures in other states that are incidental with respect to Florida employers and employees, but the FWCJUA will not provide coverage for any known or anticipated workers' compensation exposures in states other than Florida . 9 You have been assigned to Tier III, which is an assessable plan and is subject to a 170% surcharge on the annual premium . Employers qualifying for Tier III shall be required to contribute on a pro-rata-earned-premium basis the money necessary to meet any assessment levied to cover any deficit attributable to Tier III. 10 All Parties : For purposes of coverage with the FWCJUA, any employer enrolled in an employee leasing arrangement will be deemed the Employer for both its leased and non- leased workers . Therefore, a client/employer entered into a leasing arrangement to fulfill its statutory obligations to its workers through the FWCJUA shall be responsible to pay premiums to the FWCJUA that includes remuneration paid to both leased and non -leased workers. AA Increased Limits : ( in thousands) 500 / 500/ 500 2817C618172570 2 Failure to submit the information requested may result in cancellation of the policy . fo report a claim prior to policy issuance, please call 1 - 800 - 832- 7839 . Producer/ Employer: A State Authorized $ 2, 500 Deductible Plan is available . Please contact the Service Provider for an application and information regarding how to qualify. There is no premium credit associated with this option . WORKPLACE SAFETY The FWCJUA is constantly seeking effective ways to provide our Insureds with opportunities to improve safety in the work place . To enhance the many loss control and safety services provided by our Service Provider, St. Paul Travelers, the FWCJUA has partnered with The Online Safety and Security Store ( "TOSSS " ) . TOSSS provides " best in class" safety products, programs and services to clients in order to save lives, reduce costs and increase companies' profitability. TOSSS serves as the Internet's one stop safety store, which empowers FWCJUA customers to shop for safety products, take online safety related courses, catch up on the latest safety related news and OSHA regulations, or find an additional consulting service that is right for their companies - all from a single place on the Web . In order to access the site, click on the " Loss Control & Safety bar in the " Employer" section of the FWCJUA Homepage and then click on the "The Online Safety Store" link. 28170618 / 72570 3 f WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 04 20 TERRORISM RISK INSURANCE ACT ENDORSEMENT This endorsement addresses requirements of the Terrorism Risk Insurance Act of 2002. Definitions The definitions provided in this endorsement are based on the definitions in the Act and are intended to have the same meaning . If words or phrases not defined in this endorsement are defined in the Act, the definitions in the Act will apply. "Act" means the Terrorism Risk Insurance Act of 2002, which took effect on November 26, 2002, and any amendments . "Act of terrorism" means any act that is certified by the Secretary of the Treasury, in concurrence with the Secretary of State, and the Attorney General of the United States as meeting all of the following requirements : a. The act is an act of terrorism. b. The act is violent or dangerous to human life, property or infrastructure. c. The act resulted in damage within the United States, or outside of the United States in the case the United States mission or certain air carriers or vessels. d. The act has been committed by an individual or individuals acting on behalf of any foreign person or foreign interest, as part of an effort to coerce the civilian population of the United States or to influence the policy or affect the conduct of the United States Government by coercion. i "Insured terrorism or war loss" means any loss resulting from an act of terrorism (including an act of war, in the case of workers compensation) that is covered by primary or excess property and casualty insurance issued by an insurer if the loss occurs in the United States or at United States missions or to certain air carriers or vessels . "Insurer deductible" means: a. For the period beginning on November 26, 2002 and ending on December 31 , 2002, an amount equal to 11 % of our direct earned premiums, as provided in the Act, over the calendar year immediately preceding November 26, 2002. b. For the period beginning on January 1 , 2003 and ending on December 31 , 2003, an amount equal to 7% of our direct earned premiums , as provided in the Act, over the calendar year immediately preceding January 1 , 2003 c. For the period beginning on January 1 , 2004 and ending on December 31 , 2004, an amount equal to 10% of our direct earned premiums, as provided in the Act, over the calendar year immediately preceding January 1 , 2004. d . For the period beginning on January 1 , 2005 and ending on December 31 , 2005 , an amount equal to 15% of our direct earned premiums, as provided in the Act, over the calendar year immediately preceding January 1 , 2005. fCORIDA nervtrt :aF Division of Workers, FLhIAI [AE SERVICES Compensation . _ ' Tom Gallagher, Chief Fnanciat officer . IMPORTANT WORKERS' COMPENSATION INFORMATION FOR CONTRACTORS . - - - . every employee. The contractor or does not have a valid workers' must notify the employee (easing compensation exemption; the Flo dda 1 ) A contractor or sub-contractor who company of tfie names of al the contractor must contact his or her is engaged in -the construction covered employees and any workers' compensation insurance industry and employs one or more additional employees that are carrier to update his or her policy to employees must have Florida working on a jobsite That may have include such subcontractor and any ricers' compensation insurance. been excluded from the employee persons that is employed or such rperate offcecs, to addition to leasing arrangement Any change limited liability company members, in Job dutiesperformed perfoed by the sole proprietors, partners, and employees must also be reported to , independent contractors engaged the employee leasing company, in the-construction Industry are 5 = t) The Florida Division of Workers' considered employees under ) Please see the reverse side of this flyer for information about obtainiCompensation is responsible for Florida's workers' compensation ng workers' compensation insurance enforchV employer'oompfiance law. However, a contractor or and for the eligibility requirements for -With the coverage requirements subcontractor who is engaged in a construction industry exemption, of the workers' compensation law. the constriction industry and is a Comprianoe investigators have corporate ,officer or.a member of a • • . . utlwdty to conduct on-site r -limitedffabilrty a Y can apply irfspeC ioru of job sites to ensure for and,obt* a -Valid construction i) Anoutofstate' cofitraotor ° . employe rcompriance. investigators industryexemption,,, workers' can also request an Must irtitrediately notify his or req employers compensation Insurance is still her. insurance company and, . business records. An employer required for the contractors or , or insurance agent that it has : must produce the required business subcontractors employees: employees that arerecords Within fixe business da ys engagirig. in work = of the dmsibrr's written request A contractor alfrequire any in Florida. subcontractor who sub-contracts 2 for.records, if the employer fails to work from a contractor to. provide ) out-of-state construction industry respond to the request within five Pr contractor who has employees business days, the division will . evidence of Florida workers' engaged in work in Florida, must issue a stop work orderupon:tiie compensation insurance. If either obtain a Florida workers' the sub-contractor has a valid ertirptoyer regtn[id9 the empibyerlo, exemption then the subcontractor a�rperuation insurance policy or eease .al twsiifessopera6ons hn,tfie an endorsement must be added to state.. hall also provide a Dopy of his or the oiitof state contractor s her certificate of, exemption to lureicy stop work order will also be that lists Florida In section 3.A, of the 2) A contractor. �l issued to any employer who is 3) A change in job duties performed to secure Florida Workers' performed3) A Florida construction contractor. compensation coverage but fails to by employees Oran irxxease in the engaged in work,in this state do so. A stop work order will also be amount of payroll of a business who contracts with ovt-of-state issued in cases where an employer must be reported to the Insurance contractors, must require proof of may have a workers' compensation company' a Florida workers' compensation Policy but understates or conceals 4) If a contractor has secured workers' c pole3' or an endorsement to the out- c Payroll, misrepresents or conceals compensation coverage for his or of-state contractor's policy that lists employee duties or fails to utilize her employees by entering into an Florida in section 3.A, of the policy. Florida's class codes and workers' employee leasing arrangement, If the out-of-state subcontractor compensation rates: the contractor must specifically does not provide proof a Florida = 3) In order for the division to release a identify coverage for each and workers' compensation policy or stop work order, an employer must Of an endorsement to the policy, provide evidence that is has come