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HomeMy WebLinkAbout2006-331T. tfcf 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 25th Street, Vero Beach, Florida , 32960-3365; and Indian River County Healthy Start Coalition , Inc. (Recipient), of: Indian River County Healthy Start Coalition, Inc 1603 10th Avenue Vero Beach , Florida 32960 Healthy 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: FIFTY FIVE THOUSAND , DOLLARS ($55,000). 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 premises/operations , product/completed operations, contractual liability, and independent contractors ; (ii) Business Auto Liability Insurance in an amount not less than $1 ,000 ,000 per occurrence combined single limit for bodily injury and property damage, including coverage for owned autos and other vehicles, hired autos and other vehicles, non-owned autos and other vehicles; and (iii) Worker's Compensation and Employer's Liability (current Florida statutory limit. ). 5. 6. Insurance Administration. The insurance certificates , evidencing all required insurance coverages shall be fully acceptable to County in both form and content, and shall provide and specify that the related insurance coverage shall not be cancelled without at least thirty (30) calendar days prior written notice having been given the County. In addition , the County may request such other proofs and assurances as it may reasonable require that the insurance is and at all times remains in full force and effect. Recipient agrees that it is the Recipient's sole responsibility to coordinate activities among itself, the County, and the Recipient's insurer(s) so that the insurance certificates are acceptable to and accepted by County within the time limits set forth in this Contract. The County shall be listed as an additional insured on all insurance coverage required by this Contract, except Worker's Compensation Insurance. The Recipient shall, upon ten ( 10) days prior written request from the County, deliver copies to the County, or make copies available for the County's inspection at Recipient's place of business, of any and all insurance policies that are required in this Contract. If the Recipient fails to deliver or make copies of the policies available to the County; fails to obtain replacement insurance or have previous insurance policies reinstated or renewed upon termination or cancellation of existing required coverages; or fails in any other regard to obtain coverages sufficient to meet the terms and conditions of this Contract, then the County may, at its sole option, terminate this Contract. 5.7. Indemnification . The Recipient shall indemnify and save harmless the County, its agents , officials, and employees from and against any and all claims, liabilities , losses, damage, or causes of action which may arise from any misconduct, negligent act, or omissions of the Recipient, its agents, officers, or employees in connection with the performance of this Contract. 5 .8. Public Records . The Recipient agrees to comply with the provisions of Chapter 119 , Florida Statutes (Public Records Law) in connection with this Contract. 6. Termination . This Contract may be terminated by either party, without cause, upon thirty (30) days prior written notice to the other party. In addition , the County may terminate this Contract for convenience upon ten ( 10) days prior written notice to the Recipient if the County determines that such termination is in the public interest. 7 . Availability of Funds. The obligations of the County under this contract are subject to the availability of funds lawfully appropriated for its purpose by the Board of County Commissioners of Indian River County. 8 . Standard Terms. This Contract is subject to the standard terms attached hereto as Exhibit C and incorporated herein in its entirety by this reference. IN WITNESS WHEREOF, County and Recipient have entered into this Contract on the date first above written . - 3 - INDIAN RIVER COUNTY BOARD OF COMMISSIONERS By: Gory- Whe&Jer ;„ Chairman •,p BCC AQPL.oved : ,. <'ar ' • . . . . . . . . , Attest: J . K. ,fUi , clerk Deputy Clerk n i Approved : I - Jose h A. Baird County Administrator Appr7 as to form and legal suffice Bye -- Varian E. Fell, Assista ounty Atorney RECIPIENT: By: Indian River County Healthy Start Coalition , Inc - 4 - EXHIBIT A (Copy of complete Request for Proposal ) EXHIBIT - A - Indian River County Healthy Start Coalition, line. s Healthy Families Indian River Program V Children 's Services Advisory Committee Gant 2006-07 PROGRAM COVER PAGE Organization Name: Indian River County Healthy Start Coalition Inc Executive Director. Leslie Spurlock Email : IMurlock@irchealthystart.or Address: 1603 10th Ave. Telephone: (772) 563-9118 Vero Beach- Florida 32960 Fax: (772) 563-9125 Program Director: Dina Kramer Email: dkramer(a)hfirc or Address: 1603 10"' Avenue Telephone: (772) 778- 1405 Vero Beach, Florida 32960 Fax: (772) 778- 1029 Program Title: Healthy Families - IRC Priority Need Area Addressed. Parental Support and Education' supporting caregivers a child' s most important resource, to be and do what is needed to shepherd children to adulthood in a safe healthy, nurturing and productive manner. Brief Description of the Program: Healthy Families—IRC is a community based, voluntary home visitation program designed to prevent child abuse by promoting positive parent-child interaction. It teaches parents a curriculum of growth and development activities that improves a child's opportunity to grow un healthy, safe and nurtured Program staff provide services designed to promote and support healthy development of families, helping families cope and improve mental wellness and family interaction skills. These tools for at-risk families help them resolve problems in the pre-crisis stere before they become unmanageable and child abuse takes place Mental health and wellness are key components of counseling. The taxonomy definition for the Healthy Families-IRC program falls under two taxonomies: PH-236.240 — Family Support Centers and PH-620. 150 — Communication Training helps parents communicate with children health professionals and other parent/infant interaction skills, focusing on positive growth and development SUMMARY REPORT — (Enter Information In The Black Cells Only) Total Proposed Program Budget for 2006 /07 : $ 542 ,771 . 00 Percent of Total Program Budget : 10 . 1 % Current Program Funding ( 2005 /06 ) : $ 55 , 000 Dollar increase/(decrease ) in request : Percent increase /(decrease ) in request * * 0 . 0 % Unduplicated Number of Children to be served Individually : 309 Unduplicated Number of Adults to be served Individually : 256 Unduplicated Number to be served via Group settings : - Total Program Cost per Client : 960 . 66 **If request increased 5 % or more, briefly explain why: NA If these funds are being used to match another source, name the-source the $ amount: The State of Florida via Florida Ounce of Prevention — Healthy Families Florida Grant of $443,985 . The Organization 's Board of Directors has approved this application on (date) Debbie True fir , Name of President/Chair of the Board Si Leslie Executive f g�� (13( t6 Name of Executive Director/CEO tg jure 3 Indian River County Healthy start Coalition, Inc. 4 Healthy Families Indian River Program ` Children's services Advisory Committee Grant 2006-07 ORGANIZATION: Indian River Healthy Start Coalition Inc PROGRAM: Healthy Families - Indian River County TABLE OF CONTENTS Please 'X" the parts of the grant application to indicate that they are included. Also, please put the page number where the information can be located. X I Section of the Proposal Pa e # X TABLE OF CONTENTS (check list) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 -2 X COVER PAGE (with signatures). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . On Top A. ORGANIZATION CAPABILITY (one page maximum) X 1 . Mission and Vision of organization. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 X 2, Summary of expertise, accomplishments, and population served . . . . . . . . . . . . . . . . 4 B. PROGRAM NEED STATEMENT (one page maximum) X 1 . Program Need Statement. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . ... . 5 X 2. Programs that address need and gaps in service . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 C. PROGRAM DESCRIPTION (two pages maximum) X1 . Funding priority. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 X 2. Description of program activities. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 X 3 . Evidence of Addressing the Need/ Best Practice . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . 6 X4. Staffing. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-7 X5. Awareness of program. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 X 6. Accessibility of program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . 7 X D. MEASURABLE OUTCOMES (two pages maximum) . . . . . . . . . . . . . . . . . . . . . . .. . 8 X E. COLLABORATION (one page maximum) . . . . . . . . . . .. . . . . . . . . .... . . . . . . . . . . . . . . . .. 9 F. PROGRAM EVALUATION (two pages maximum) X1 . Demographics. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 X2. Measures. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 X3. Reporting. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 X G. TIMETABLE (one page maximum) . . . . . . . . . . . . . . . . . . . . . . . .... . . . . . . . . . . . . . . . . . . . . 11 H. UNDUPLICATED CLIENT COUNT X 1 . Projections by Location . . . . . . . . . . ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 X 2 . Projections by Age Group . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 1 Indian River County Healthy Start Coalition, Inc. r Healthy Families Indian River Program s Children's Services Advisory Committee Grant 2006-07 I. BUDGET FORMS X 1 . Financial Budget Forms. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 1 . Budget Narrative Worksheet 4 pages B- lA, 1B, 1C, 1D 2. Total Agency Budget 1 page B-2 3. Total program Budget 1 page B-3 4. Funder Specific Budget 1 page B-4 5 . Explanation for Variances 2 pages B-5A, 5B J. FUNDER SPECIFIC/ADDITIONAL SHEETS These additional sheets can be found attached to the TLC Newborn Grant with the exception of the Healthy Families Taxonomy and Goal Testing _ Materials 1 . List of Current Officers and Directors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2. IRC Healthy Start Coalition Financial Audit — Year ending June 30, 2005 3. IRC Healthy Start Coalition IRS Form 990 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4. IRC Healthy Start Coalition Balance Sheet and Operating Budget . . . . . . . . . 5 . Staff Organizational Chart . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6. 501 (c)3 IRS Exemption Letter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7. Articles of Incorporation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8. Agency Bylaws . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9. Agency policy regarding Affirmative Action . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10. Not for Profit Agency Certification . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 . Authorization for Release of Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. Nepotism Statement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . X 13.Taxonomy Definition for Program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 X 14. Goal Testing Materials . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Ages & Stages Questionnaire, PSI 2 iiiiiiiiiiiiiiiiiiiiiillillillillillillilliillillilliilililI Indian River County Healthy Start Coalition, Inc. Healthy Families Indian River Program Children's Services Advisory Committee Grant 2006-07 PROPOSAL NARRATIVE a. ORGANIZATION CAPABILITY 1 . Provide the mission statement and vision of your organization. The Coalition' s mission is to establish a system in Indian River County that guarantees all women access to prenatal care and all infants access to services that promote normal growth and development. Our vision is to provide every family the opportunity to maximize their child' s potential before, during and after birth. Our programs concentrate on the significance of caregivers' relationships with the baby because caregivers are the infant's environment; an environment that impacts the infant's physical well being and emotional/mental health for life. The Vision/Mission for the HF IRC program is "To enhance parent's ability to promote and maintain healthy family life through education and coordinated support which is individualized for each family." 2. Provide a brief summary of your organization including areas of expertise, accomplishments, and population served. The Coalition, incorporated in 1993 is a private not for profit established by Indian River citizens interested in having local control of state and federal dollars for maternal child health. Through a state legislated grant our prenatal and infant health care coalition is annually awarded operating funds of $ 150,000 per year to plan, implement and evaluate maternal child health in Indian River County. This is accomplished by establishing a partnership between the private and public sector, state and local government, community alliances and matemal and child health providers to provide coordinated community based care for pregnant women, infants and families. State and local program dollars are allocated to providers for services for pregnant women and infants. Since the Coalition was organized, the county's infant death rate has dropped from a rate of 12.04 in 1993 to 3.63 in 2003 . All pregnant women and infants in the county are served by the universal Healthy Start/Healthy Families risk screenings and depending on their need, are provided opportunities to participate in Healthy Start, TLC Newborn and Healthy Families. Universal screening of newborns has risen from a low of 41 % three years ago to 93% in 2005 . Healthy Start and Healthy Families programs provide services for children prior to birth. Both Coalition and program staff work with IRMH and providers (obstetric and pediatric) to facilitate entry. Additionally the Coalition administers MomCare, a Medicaid Choice Counseling program that is contracted out to IRC Health Department. Because the Coalition is the lead agency for all four, we are in a position to implement efficiencies, eliminate duplication and facilitate movement of families between programs as their needs are identified. Areas of expertise include birth and maternal data analysis, program planning, development, implementation, and addressing gaps in maternal child health services. Once gaps in service or poor birth outcome trends have been identified, then necessary steps are taken to improve these gaps in care by building bridges, linkages or adding new services if they currently do not exist to meet the needs of families in Iridian River County. IRC Healthy Start Coalition uniquely focuses on programs that provide services at the earliest stages of a child' s life because research has shown that bonding; of parent to child, and attachment; of child to parent, has a lifelong impact on a child's life affecting school readiness and their mental, emotional and physical health as they grow into adulthood. 4 Indian River County Healthy Start Coalition, Inc. ' Healthy Families Indian River Program ` Children 's Services Advisory Committee Grant 2006-07 B. PROGRAM NEED STATEMENT (Entire Section B not to exceed one page) 1 a) What is the unacceptable condition requiring change? Pregnancy and raising a child places many new or additional burdens and stressors on a family, including financial, emotional and even physical stress. Along with the joys of parenthood can be the realization of the major responsibilities of raising a child to be healthy and ready to learn by the time they enter their school years. HF focuses on families with risk factors for child abuse by addressing parenting components that improves parent/child interactions and enhances overall brain development. b)Who has the need? Factors associated with increased risk for child abuse, poor birth outcomes and poor infant/child growth and development include: marital status, age of mother, moving three times in one year, alcohol or substance use, high stress level, not wanting the pregnancy, depression, history of mental health counseling, and partner being unemployed. In many cases, these risk factors are more prevalent for low income families. Indian River County residents had 1 ,056 births in 2002. Of these births, 62. 8% were from white mothers, 15 .3% black, 19.0% Hispanic and 2.9% "other" mothers. In 2002, almost half, or 45% of all births are covered under Medicaid or indigent funding. Of all the births in 2002, 39. 6 % of babies born were to unwed mothers, with black unwed births at 76.5 %. In terms of education status of the newborn's mother, 28.3% of the mothers did not have a 12'h grade education or GED. c)Where do they live? Healthy Families — IRC serves families from the entire county, with 53% served from south county, and 47% from the north county area. d)Provide local, state, or national trend data, with reference source, that corroborates that this is an area of need. All Healthy Families Florida programs are modeled after the highly successful national HF America initiative and are recognized by Abuse America/Healthy Families America as providers of high quality home visitation services. Critical program elements have been defined by over 20 years of research and represent best practices in home visitation. There is 20% less maltreatment of children in families parti6pating in Healthy Families than all families in the target area. 1 2. 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. Healthy Start Care Coordination provides ongoing case management to high-risk pregnant women and infants, placing emphasis on the pregnant woman to help ensure a healthy birth outcome. The Healthy Families IRC program is designed to begin prenatally or at the birth of the child and is a voluntary program. No other child abuse prevention program is voluntary. Healthy Families focuses on parent/child interaction until the parents complete the program or the child reaches age five. TLC Newborn also focuses on interaction, but is not a home visiting program. The focus of Healthy Families IRC is to prevent child abuse. Healthy Families requires low caseloads be maintained at an average of 20 families per worker, but no more than 25. Healthy Start has case loads of 50-70. Healthy Families participants receive Weekly visitation and must demonstrate improved knowledge to move to less visitation. Healthy Start's highest level of service requires twice monthly visitation. The low caseloads and the extended duration of services greatly enhance the opportunity to positively impact families. Healthy Families-IRC is the only program in Indian River designed to serve families for up to five years. Healthy Families Evaluation Report 1999-2003 Executive Summary. Williams, Stem & Associates. V. 5 Indian River County Healthy Start Coalition, Inc. Healthy Families Indian River Program • Children's Services Advisory Committee Grant 2006-07 C. PROGRAM DESCRIPTION (Entire Section C, I — 6, not to exceed two pages) 1 . List Priority Needs area addressed. Parental Support and Education: supporting caregivers, a child' s most important resource, to be and do what is needed to shepherd children to adulthood in a safe, healthy, nurturing and productive manner. 2. Briefly describe program activities including location of services. HF Florida and the Florida Department of Health have collaborated to develop a Universal Prenatal Screen. The screen is offered to the pregnant woman on her first obstetric (OB) visit with her prenatal care provider and the screens dramatically improve the referral process. HF-1RC receives the screens from the HS Care Coordination office and makes contact with all pregnant mothers who had an initial positive screen for HF. Services can be initiated either prenatally or up to two weeks after the birth of the target child and this is determined prior to assessment. Once the positive HF screen is received the FAW conducts a face-to-face two-hour comprehensive assessment to determine if she would be eligible for HF services. Healthy Families is a voluntary, intensive home visitation program that occurs on a weekly basis. Caseloads are designed to be kept to fewer than 25 families to ensure the intensity of the home-based services are manageable. Intensity and duration decrease over time as a result of the parents' achievement of goals. Services take place in the home. Family Support Workers (FSW) are highly trained and supervised paraprofessionals who provide services focusing on parent/child bonding, infant/child growth and development, well baby care and immunization compliance. They support the family by empowering them to set and achieve goals. HF IRC encourages and helps families become employed as a number of the families are unemployed. One hundred percent of the families being served have conformed to their well child/EPSTD standards (which includes immunizations), with a significant majority of the families surveyed showing overall satisfaction with services. 3. Briefly describe how your program addresses the stated need/problem. Describe how your program follows a recognized "best practice" (see definition on page 12 of the Instructions) and provide evidence that indicates proposed strategies are effective with target population. HF works with families at risk for child abuse by addressing and modeling parenting behavior that will improve parent/child interactions, thereby enhancing the child' s mental health, physical health and physical development. The HF program is modeled after the highly successful national HF America; an initiative that is based on critical program elements that have been defined by over 20 years of research and represent best practices in home visitation. HF Florida, which is the state-based administrator of all HF programs, contracted with a research and evaluation firm to conduct overall program evaluation. In a report presented in. April 2002, itfoundthat 98% of all children who participated- in HF had no finding of child maltreatment or substantiated child abuse. The national HF initiative has many years of research and has demonstrated the success of the Healthy Families' model as an effective means of promoting positive enhancing family functioning and preventing child maltreatment. 4. List staffing needed for your program, including required experience and estimated hours per week in program for each staff member and/or volunteers (this section should conform with the information in the Position Listing on the Budget Narrative Worksheet), Project Manager ( 1 Full Time Equivalent - FTE) - Masters degree in social work, psychology, 6 Indian River County Healthy Start Coalition, Inc. Healthy Families Indian River Program Children's Services Advisory Committee Grant 2006-07 or a related field (or BA with 2 additional years of experience in the field), and/or 2 years experience in direct service delivery and supervision. The primary role is to provide leadership, direction and overall program supervision for all HF IRC staff. Supervisors ( 1 .5 FTEs) - Masters degree in social work, psychology, or a related field (or BA with 2 additional years of experience in the field), and 2 years experience in direct service delivery and supervision. Duties are to report to Program Manager, provide direct supervision of FSW's and to review caseloads of HF IRC staff. Family Assessment Worker ( 1 . 5- FTE's) - One-year college credit in a related field, with two years of experience delivering services to children and families. Duties are to review referrals made by OB providers or other sources in the community and to interview/conduct using the eligibility tool with parents to determine eligibility for HE Family Support Worker (8 FTE 's) - One-year college credit in a related field, with two years of experience delivering services to children and families. Responsible for initiating and maintaining regular (at least weekly) and long-term contact/support with families. Data Entry Clerk—Admin. Asst. ( 1 FTE) - Accurate and timely information processing; experience with data entry computer systems. Duties include the review of master copies of documents; updates HF IRC database. 5. How will the target population be made aware of the program? Identification of potential HF clients is accomplished through universal HS/HF screening of pregnant women at all OB providers' offices. Partners in Women's Health is the primary obstetric Medicaid provider in this county, who has the highest number of patients eligible for Healthy Families. At Partner's a midwife provides information to pregnant women during a weekly orientation about the provider and community programs, including a short video about Healthy Families. IRMH also provides HF program referrals. As the lead agency for HF IRC, awareness is created through Coalition networking and our two other programs; Healthy Start Care Coordination and TLC Newborn. The Coalition promotes the program through its website, public presentations, quarterly Coalition meetings, and at health fairs or other public events. 6. How will the program be accessible to target population (i.e., location, transportation, hours of operation)? The HF IRC program serves the entire county. Since HF IRC is a home visitation program, there are few barriers for program participation. Transportation for HF services is not a problem. All Family Support Workers have flexible hours and work evenings or weekends in order to visit families at the family's convenience. Although home is the primary site of visitation, staff can arrange visitation at OB or pediatric provider offices, WIC or any other location convenient to the family. 7 Indian River County Healthy Start Coalition, Inc. Healthy Families Indian River Program Children's Services Advisory Committee Grant 2006-07 D. MEASURABLE OUTCOMES (Description ofintent) OUTCOMES ACTIVITIES Add all the elements for the Measurable Outcomes Add the tasks to accom lirh the Outcome(s) Note: These outcomes and activities are based on the standard HF Florida and national HF program guidelines and requirements. 1 . Ninety (90) percent of target children will 1 . The Family Support Worker will address be fully immunized by age two (2). immunization schedules with family and record usage. 2. Ninety (90) percent of target children will 2. Families will be encouraged to seek and be up-to-date with Well-Baby Checks. utilize a pediatrician and/or clinic for ongoing medical care for infant and child. The infant's medical home will be established and Well Baby checkups will be monitored. 3 . Ninety (90) percent of the children in 3 . FS W' s will address proper parenting skills families who participate for six months or with the family, as well as Shaken Baby longer will have no verified child maltreatment Syndrome Education, partner interaction and while receiving Healthy Families services or anger management. findings of some indications of maltreatment. 4. At least eighty (80) percent of all 4. The Family Assessment Worker will assessments must occur either prenatally or conduct assessments per referral during the within the first two weeks after the birth of the target period for HF client enrollment. target child. 5 . Ninety (90) percent of families enrolled 90 5. A Family Support Plan will be written for days or longer will have updated their all enrolled participants, developing mutual Individual Family Support Plan within the goals and activities the family will strive to previous ninety days. obtain. 6. At least 90% of participants will be 6. HF participants will be given the Parenting administered the baseline Parenting Stress Stress Index (PSI) by their Healthy Families Index within 3 weeks of their baby's birth. IRC FS W within 3 weeks of their baby's birth. 8 Indian River County Healthy Start Coalition, Inc. Healthy Families Indian River Program Children 's Services Advisory Committee Grant 2006-07 E. COLLABORATION (Entire Section E not to exceed one page) 1. List your program's collaborative partners and the resources they are providing to the program beyond referrals and support. (See individual funder requirements for inclusion of collaborative agreement letters. CoUaboratdve Agency Resources provided to the program Indian River County Health • Provides coordination of HS/HF prenatal screen. Department • Communication on potential HF client's status. Services are provided in-kind. • Medical/nursing based services for HF client on an "as-needed" basis. • WIC and needed health care services at CHD clinics. Indian River Memorial Hospital • The hospital works with the Healthy Start Services are provided in-kind. Screening Liaison to facilitate the Universal Infant Screen and provides space and a computer. IRC Library — Born to Read • Provides two books and a book-bag to families Program with a newborn who participate in HF IRC. The Services are provided in-kind. HF IRC emphasizes the importance of reading to their infant to enhance brain development. Partners in Women 's Health • Primary site for Healthy Families referrals. Services are provided in-kind. Partner's employees provide HF IRC orientation, education, and processing of the Universal Healthy Start Screen. Indian River County Healthy Start • Overall program development, integration and Coalition communication within all three IRCHSC programs. (While the Coalition is the applying • Office Space at no cost to HF IRC. agency, many in-kind collaborative • PR and marketing of HF IRC Program efforts on behalf of the HF IRC • QA/QI oversight. program take place) • Accounting, fiscal reporting and audit preparation. • HF IRC representation at public events. • Develo ment and resentation of HF IRC grants. 9 Indian River County Healthy Start Coalition, Inc. Healthy Families Indian River program Children's Services Advisory Committee Grant 2006-07 K PROGRAM EVALUATION (Entire Section F not to exceed two pages) 1 . DEMOGRAPHICS : What information (data elements) will you need to collect in order to accurately describe your target population including demographics (age, gender, and ethnic background) required by the funder in Section H? What are the pieces of information that qualify them for your target population? How do you document their need for services or their "unacceptable condition requiring change" from Section Bl ? Comprehensive data on each HF IRC family who enrolls is entered into a web based Healthy Families database, developed and maintained by Healthy Families Florida. Data includes demographic information. The parent(s) and the Family Support Worker monitor infant developmental stages, with updates documented in a written family record. HF IRC participates in statewide evaluation and provides outcome and performance data in the format and frequency specified by Healthy Families Florida. The HF Florida database is updated on a weekly basis, and reports are also generated weekly. Reports are provided to the Project Manager and Supervisor, who then share the general information and/or discrepancies with the appropriate FSW. The Healthy Families Florida Contract Manager from Tallahassee performs site reviews quarterly. This includes a review of HF IRC local Advisog Board activities. 2. MEASURES: What data elements will you need to collect to show that you have achieved (or made progress toward) your Measurable Outcomes in Section D? What tools or items are you using as measures (grades, survey scores, attendance, absences, skill levels) for your program? Are you getting baseline information from a source on your Collaboration List in Section E? Are there results from your Activities in Section D that need to be documented? How often do you need to collect or follow-up on this data? The outcomes are based on data required by HF Florida (HFF) that are compiled and entered into the statewide database by HF IRC at regularly scheduled intervals. Based on strict HFF criteria, families develop goals based on their assets and needs, and must achieve goals to "graduate" to higher levels. A higher level results in less intensity of services, and empowers the family to become self-sufficient. The required data and outcomes are monitored by HFF, as well as locally by the HF IRC Program Manager and the Coalition. These measures are based on 30 ears of research by Healthy Families America. 3. REPORTING: What will you do with this information to show that change has occurred? How will you use or present these results to the consumer, the funder, the program, and the community? How will you use this information to improve your program? The database is updated weekly with data reported by the FSW for each family. Reports are also generated weekly by the Supervisor so that they can be reviewed with the family's FSW during Weekly supervision. Data and programmatic reports are provided to the Coalition Executive Director weekly. Data and programmatic reports are submitted to the HF IRC Advisory Board, and Coalition Board of Directors monthly at regularly scheduled meetings. CSAC receives reports quarterly. HFF Contract Manager reviews reports for HF IRC monthly and conducts on- site QA/QI every three months. Reports are provided at the public Coalition meetings quarterly. All QA/QI partners, including Healthy Families Florida, the Advisory Board and the Coalition monitor program outcomes and work towards strategies and solutions when issues are identified. 10 Indian River County Healthy Start Coalition, Inc. Healthy Families Indian River Program Children's Services Advisory Committee Grant 2006-07 G. TIMETABLE (Section G not to exceed one page) 1. List the major action steps, activities or cycles of events that will occur within the program year. New programs should include any start-up planning that may occur outside the funding year. In com ing the timetable, review information detailed in prior sections. Month/ Activities Period The major steps for the overall program are: Weekly Pregnant women are offered the universal HS/HF screen by OB providers in all counties. The voluntary screen identifies risk factors for child abuse. With client consent, HF IRC receives a copy of all screens from the Health Department. Referrals also come from the social worker at Indian River Memorial Hospital at the time of birth. Additional referrals may come from any agency in the community. Families can be eligible for assessment during pregnancy or up to two weeks after the birth of their child. The Healthy Families Family Assessment Worker (FAW) conducts a face-to-fac assessment to determine if they are eligible for Healthy Families. The FA communicates with the HS Care Coordination team to determine their status with H status prior to performing the assessment. On-going, After the assessment, if the family is eligible for Healthy Families, and is interested in up to 5 participation, the Program Manager reviews the case with the FAW. The case (family) years then goes to the HF Supervisor, who reviews the family's needs and determines the best Family Support Worker (FSW) for case management assignment. The family is then assigned and phone contact must be attempted within 72 hours by the FSW. A subsequent home visit attempt must be completed within 5 days. Once contact is made with the family, initial goal setting is done within one month of opening the case. Supervisors review all cases assigned to every FSW weekly for a minimum of two hours. Goals are reviewed and updated with the family and Supervisor every 90 days. These goals can be modified during 90 days if needed. For pregnant women, the determination of weekly or bi-weekly visits during pregnancy is made. After birth, visits are weekly for a minimum of 6 months. Bi-weekly visits can be conducted if the mom returns to work, with phone contacts in between. Six to eight months after birth, the Supervisor and FSW will determine if the family can move_ to level two, where the family will receive- bi-weekly visits. This - determination is based on the family's progress in meeting their goals as well as overall family needs. The Ages and Stages Questionnaire Child Developmental Assessment tool (available in Spanish and English) is conducted every four months and goes all the way to 60 months. A copy of the first one is attached. The Parent Child Assessment/Observation tool is completed at one month, then every six months. Home Safety checks are conducted at one month then again at six months. The family and target child must complete goals and advance through levels to achieve program graduation. 11 Indian River County Healthy Start Coalition, Inc. Healthy Families Indian River Program Children's Services Advisory Committee Grant 2006-07 H. PROJECTIONS FOR UNDUPLICATED CLIENTS Number of Undu licated Clients by Location Last Fiscal Year Current Fiscal Year Next Fiscal Year Location Actual 2004/2005 Budget 2005/06 Projections2006/07 Unduplicated Clients Unduplicated Clients Unduplicated Clients N. Indian River County 171 280 309 S. Indian River County 193 230 256 Indian River Co. Total 364 510 565 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 3641 510 565 Number of Unduplicated Clients by Age Last FiseW .Vear ` Current Fiscal Year Next Fiscal Year Location Actual x/20. Budget 2005/2006 Projections 21106/07 lFndi d Group Individuals Group individuals Group 0 to 4 - (Pre-school) 182 - 202 - 222 - 5 to 10 - (Elementary) - 62 - 73 - 11 to 14 - (Middle) - 1S-toIS - (High School) 12 _ 2 _ _ 3 Total Children 194 - 277 _ 309 _ 19 to 59 - (Adults) 170 - 233 - 256 - 60 + (Seniors) EE Total Adults - 233 - 256 - TOTAL SERVED 364 - 510 - 565 - 12 Indian River County Healthy Start Coalition, Inc. Healthy Families Indian River program Children 's Services Advisory Committee Grant 2006-07 I. BUDGET FORMS - To open the Budget Forms, please double-click on the icon below Financial Budget Forms 1 . Budget Narrative Worksheet 4 pages B- IA, 113, 1C, 1D 2. Total Agency Budget 1 page B-2 3 . Total program Budget 1 page B-3 4. Funder Specific Budget 1 page B-4 5. Explanation for Variances 2 pages B-5A, 5B A note of explanation on the budgets : The budgets' `agency' figures reflect the program revenue and expenses. The Coalition, by state statute is prevented from using state funds designated for operating the Coalition on any direct service programs. We are also prevented from paying or employing staff with those dollars to provide maternal child services directly to participants. All programs that we administer are contracted out to other agencies that provide the services. We contract with Kids Connected by Design to provide HF IRC services. "Core Budget Forms" 13 Indian Piver County Healthy Stan Coalition Healthy Families IRC Program UNIFORM GRANT APPLICATION BUDGET NARRATIVE WORKSHEET IMPORTANT: The Budget Narrative should provide details to justify the amountrequested 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 : Indian River County Healthy Start Coalition/Healthy Families IRC FUNDER: IRC Children's Services Advisory Committee 7 . — . . — . . — . . — . . — . . — . . — . . . . . . . . . . . . . . . . . . . . . . . . . . . . . — . . — . . — . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . t CAUTION : Do not enter any figures where a cell is colored in dark blue - Formulas and/or links are in lace. Gra areas 'should I ibe used for calculations and to write information only. REVENUES � cvueeaiv Proposed Total Program Funder Specific TotalAgency twow oerxe. s a t Budget Budget Budget 1 Children's Services Council3L Lucie 2 Children's Services Council-Martin 3 Advisory Committee4ndian River 55,000.00 55,000.0 55,000.00 4 United WaySt. Lucie County - 5 United Way-Martin County. 6 United Way4ndian River County 7 Departmenit of Children & Families 443,985.00 443,985.00 8 County Funds . 9 Contributions-Cash 10 Program Fees 11 Fund Raising Events-Net 12 Sales to Public - Net 13 Membership Dues 14 Investment Income 15 Miscellaneous 16 Legacies & Bequests 17 Funds from Other Sources 18 Reserve Funds Used for Operating 19 InaCind Donations (Not included in tow) 50,996.00 20 TOTAL REVENUES doesn1 include line 19 $498,965.00 - $55,000. $498,985.00 A 8 C D EXPENDITURES `, m y . I;lal;t Proposed Total Program Funder Specific Total Agency Iswvancuw Budget - Budget Budget 21 Salaries - (must complete chart on next page) 312,841 .00 51 ,091 .50 312,841 .00 Salary 22 FICA - Total salaries x 0.0765 7.65% 23,932.33 _ 3,908.5023,932.3 lreme - Annual pension tor qua I I _ 23 staff I % match over 1 year employed 5,000.00 0.00 5,000.00 Liteffleafth - ip n rm 24 Disab.$437x13x12months $437/m0n6uA3 62,928.00 0.00 62,928.00 Workers Compensation - 13 employees x 25 .0118 rate 0,0118 2,700.00 0.00 2,700.00 Unemployment - 13 prolected 26 employees x $7,000 x .007 UCT-6 rate 0.007 1 ,400.001 0.001 1 ,400.00 SALARIES A B D POSITION LISTING Gross Annual Portion of Salary on Proposed C % of Gross Annual Salary Funder Specific Budget Salary Position True / Total Hrs/wk (Agency) Program Requested(CIA) Example: Executive Oirectarr40 ins 70,000:00 10,000.00 5,000.00 7.14% t o05 -t ai - A Indian River Cwnly Healthy Slag Coalition Healthy Pamlies IRC Pragram Program Manager 45,482.00 45,482.00 0:00% Supervisor 28,634.00 28,634.00 0.000 SupervisorlFAW28,600.00 - 28,600.00 0.00% FAW 23,088.00 23,088.00 - 0.000 8 FSW 164-,944.00 164,944.00 51 ,091 .50 30.980/ Data Entry/Admin Clerk 22,093.00 22,093.00 0.000 #DIV/0! #DIV/O! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIVlO! #DIV10! Remaining positions throughDut the agency Total Salaries $312,841 .00 . $312,841.00 $51 ,091 . 16.330/ FRINGE BENEFITS DETAIL A (Funder Specific Budget Funder B Pension D Worker's u„emPmyme howl Fringes Column C only, from line 22 to 27) Specific FICA 7.55% Health Ins ng Funder Position TWO / Total Hrs/wk Budget (A x %) Compens. m Compens. Specific Example: Cue Manager/40his 4000.00 382.50 - 200.00 500.00 - 300.00 200.00 1,582.50 Program ManagerO.pO - 0.00 0 .00 Supervisor - 0.0 0.00 0.0 01 Su isor/FAW 0.001 0.00 0.0 01 FAW - 0.0 0.00 - 0.0 01 8 FSW 51 ,091 .501 3,908.50 3,908.501 Data Entry/Admin Clerk 0. 0.00 p.p 0 0.0 0.00 0.0 0 0.00 0.00 0.001 0 0.0( 0. 0 0.00 0.00 0.001 0 0.0 0.00 0.0 0 0.00 0.00 0.001 0 0.00 0.00 0.0 0 0.00 0.00 0.0 0 0.00 0.00 0.001 0 0. 0.00 0,001 0 0.00 0.00 0.0 p o.00 o.00 o.o 0 0.0 OAO 0.0 0 _ _ . ._. . . . . -. - 0.0 0.00T-----F- en .00 - 0. Total Wnder Request Fringe Benefits 51 ,091 . 3,908. 0.0 0.00 .00 3, 8. A B C D EXPENDITURES � Proposed Total Program Funder Specific Total Agency Budget Budget Budget 27 Travel-Daily - 29,260.00 29,260.00 # of Staff x average # of miles/wk x 50 wks x Avg: 52 As x $559 - state rate of $ = Estimated Daily Travel/MBeage Reimb. - 44.5cents/mile 28 Trave#Conferencesrrraining 3,500.00 3,500.00 5/168006 B-1 Indian River Cwnty Healthy start Cealihon Healthy Famlies IRC Program - National Conference (cast per staff) • Training/Seminar (cost per staff) • OtherTrainings (cost of travel, lodging, Mandatory refresher and new hire registration, food) training. 2 statewide HFF conferences. 29 Office Supplies 6,000.00 6,000.00 • Office supplies (monthly average x 12 months = estimated cost of office supplies based on present history. $500/month x 12 months; staff of 13 30 Telephone 7,000.00 =300.00 # Phone lines x average cast per month x 12 months = local phone cast • Average long distance ells x 12 months = 3 phone fines; 13 voice mailboxes @ $255/mo; cell phone reimbursement Estimated cast of long distance $201mo x 13 31 Postage/Shipping 300.0( • Quarterly Mailing of Newsletter - Special events, etc. Participant letters. Report packages, • Bulk mailings - appeals contracts mailed to HFF. 32 Utilities 1 ,200.00 q3,610.00 • Electricity ($ x 12 months) • Water/Sewer ($ x 12 months) $100 x 12 months; 50% of monthly • Garbage ($ x 12 months) invoice 33 Occupancy (Building & Grounds) 3,610.00 • Mortgage/Reat ($ x 12 months) - Janitorial ($ x 12 months) - Storage for materials and data $238 x 12 Buile ing/AC Maintenance • Grounds Maint. ($ x 12 months) $750/annual No funds for rent/ receive - Real Estate Taxes in-kind from IRC Healthy Start Coalition 34 Printing & Publications 100.00 100.0 • Quarterly Newsletter ($ x 4) • Letterheads,. Envelopes, etc. - Fundraising materials • Other business cards 35 Subsaription/Dues/Membeirships 275.0 - 275.0 • Membership to National Organization • Dues • Subscriptions to Newspapers/magazines, Prevent Child Abuse America Annual etc. Dues 36 Insurance 0.0 • Directors/Officers Liab. • Commercial/General Insurance Health insurance $437x13 x 12 months • Bond Ins. _ $62,928. Wcomp @ .0118. Officers, • Auto Insurance liability covered by KCBD 37 Equipment:Rental & Maintenance 750.00 750.0 • Copier tease ($ x 12 months) - Meter lease ($ x 12 months) • Copier Maintenance ($ x 12 months) • Computer Maintenance ( $ x 12 months) • Other =Maintena� 2=$750 38 Advertising 400.00 400.00 • Newspapet ads - • Fundraising ads/promotions Newspaper classifieds to fill vacant • Other (vacancies) positions; 2 x $200 39 Equipment Purchases:Capital Expense 0.00 0.00 • Computer/monitor (# x $) - • Laser Printer NA 40 Professional Fees (Legal, Consulting) 000 • Legal advice ( estimated #hrs x $) Consultant fees • Other 41 Books/Educational Materials 100.00 100.00 • Books/videos • Materials ($ x staff) brochures for participants 42 Food & Nutrition 0.00 0.00 sn srzoos - a-t Indian River County Healthy Start Coalition Healthy Fanilies IRC Program • Meals ( f/ meals x clients x 5days x 50 wks) • Snacks NA - - - 43 Administrative Costs 17,230.21 17,230.21 • Admin. Cost (% of total budget) Up to 10% Of total budget for IRCHSC 44 Audit Expense 2,000.0 2,000.00 • Independent Audit Review 20% of annual agency audit 45 Specific Assistance to Individuals 100.00 • Medical assistance 100.00 • Meals/Food • Rent Assistance • Other Incentive items for participants 46 Other/Miscellaneous 175. 175.00 • Background check/drug test • Other background, drug testing . 4 Other/Contract 18,183. 18,183.46 • Sub-contract for program services 4% of adjusted budget to KCBD 48 TOTAL EXPENSES $498,985.00 $55,000.0 $498,985.00 5/1&2006 B-i UNIFORM GRANT APPLICATION TOTAL AGENCY BUDGET AGENCY/PROGRAM NAME: Indian River County Healthy Start Coalition/Healthy Families IRC FUNDER: IRC Children's Services Advisoi Committee FYE June 30, 2005 FYE June 30. 2006 FYE June 30, 2007 CURRENT VS. NEXT FY BUDGET A B C p ACTUAL TOTAL PROPOSED Ica. cc . ayew. B REVENUES BUDGETED BUDGETED 1 Children's SerVICes Council-St Lucie 0.00 #DIV/Ol 2 Children's Services Council-Martin 0.00 #DIV/O! 3 Advisory Comm!ttee4ndian River 59 500.00 55,000.00 55,000. 0.00% ILtied Wa SL Lucie Coun 0.00 NON/Ol Unded Wa -Martin County 0.00 #DIVI01 61 United Way4nr1!an River County 0.00 /�IV/01 =Ralsi f Children & Families - 443 985.00 443;985. 443,965.00 0.00% 0.00 NDN/01 -Cash 0.00 #DNlol 1 0.00 NDN/01 tEvents-Nat 0.00 #W/OI I ic-Net 0.00 NONIO! 13 Membership Dues 0.00 #DN/01 14 Investment Income 0.00 #ON/O! is Miscellaneous 0.00 iDN/01 is actes & Beauests - 0.00 #w/0! 17 Funds from Other Sources 22,800.00 0.00 #DIV/01 is Reserve Funds Used for Ooeratino 0.00 #DIVfO1 191n4Und Dohations omr naoaw m fare 0.00 #DIV/01 20 TOTAL 526oMOO 498 985.00 498 985.00 0.00% EXPENDITURES 21 Salaries 321 461.00 312 .00 312 386.00 O.00Y. 22 FICA 24,591.76 23 .00 932.33 0. 23 Retirement 0.00 0.00 5,000,00 mnrrol 24 L7fetWealth 43630.24 53,MW 62,928.00 16.66% 25 Workers Compensation 101&00 ZTOO.00 2700.00 0.00% 26 Florida Unem b t &00 1400.00 140000 :20.00% 0.00% 27 Travel-Dai 21466.00 000.00 29 260.003.00% 28 Trovel/Conferenees/Trainin 0.00 4 10.00 500.000,63 29 OfRce les 7,312.00 M,00 6,000.009.38 3o Telephone 10 8 5.00 11 346.00 7,000.008. 31 Postage/Shipping217.00 250.00 300.00 3z Utilities 4741.00 40&00 1,2D0.00 X4.77% 33 Occupancy (Building & Grounds 759.00 2g7O4,OO 3 610.00 33.51 % 34 Print-tag & Publications 3 060.00 2AM.00 100.00 -95.8 35 Subscription/Dues/Memberships 350.00 275.00 -21.43 >e Inwronre 11000. 0.00 -100.00% 37 E ui Rantal & Maintenance 1150.00 750.00 -34.78% se Advertise 524.00 400.00 -23.66 3s Equipment Purchases:Ca I Expense 0.00 0.00 MW/O! 4o Professional Fees (Legal. Ca suldn 02S-,9W16&nn 0.00 0.00 #DIV/01 41 Books/Eduratlonal Materials 500.00 100.00 4{0.00% 42 Food & NuWwn 0.00 0.00 #DN10! 43 Administrative Costs 29797.00 17230.21 .42.17% 4a Audit Expense 2,000.00 2.000.00, 0.00% 45 SPedfw Assistance to bdividuals 22 800.00 11000.00 100.00 -90.00% 46 OtheNMiscellaneous background screeni165.00 175.00 6.06% 47 OthadControet 2967.00 15,421. 16183.46 17.91% 4oTOTAL 526 285.00 498 531.00 498 530.00 0.00% 49 REVENUES OVERT UNDE EXPENDITURES O.DO 454.00 455.00 0.22 3 _ � INn lOv mnbweTVSon CwW. i wYlryf�iiswCRq�n ' UNIFORM GRANT APPLICATION TOTAL PROGRAM BUDGET AGENCY/PROGRAM NAME: Indian River County Healthy Start Coalition/Healthy Families IRC FUNDER: IRC Children's Services Adv!so Committee FYE June 70, 2005 FYE June 30, 2006 FYE June W, 2006 CURRENT ' 5. NEXT FY BUDGET A B C D ACTUAL TOTAL PROPOSED Ica. CKa. ayca 6 REVENUES BUDGETED BUDGETED , Children's Services Council-SL Lucie 0.00 #DIV101 Children's Services Coundi-Martin 0.00 SM101 7 Advisory commlt•e4nafan River 59 500.00 55,000. 55 000.00 0. Untied Way-St Lucie County 0.00 #W/O! United W -hlarOn County0.008DW/Ol United W -IrMian River Countv 0.00 #w/o! 7 of CAIWren i Families 965.00 443 985.00 443985.001 0. Cou Funds 0,0018DW/01 Caddbuuons-Cash 0.0ol #MM rmrr Fees 0.00 MXV101 „ Fund Reisi EvaMs-Nat 0.001 YDW/01 Shea to Public-Net - 0.00 SM/01 ,a Membarsh Dues 0.00 #OW/01 ,I Inprrre - 0.001 8OW/W lanaous 0.00 SWIM 3 0.00 iDlvrol , 2Z$00.00 0.00 iDN101 7a Reserve Funds UsW for 0.00 8DW101 ,e N40rM DoMlions gaeceiereMmry 50996.00 #DIV101 20 525.MOD 498965.00 498M5.0( o.00vj EXPENDRURES 21 Salades 321 1.00 312A86.00 31Z386.00 0. FICA i. A932.00 23 93233 0.00% 27 Retiremq,t 0.00 G.Do - 5000.00 XMI01 LlfeDfesitlr4SAX24 530x00 928.00 18.88 Workws salon 1046.00 21700.00 23700.00 0.00% FbrWa 0.00 1400.00 1400.00 0.0D% ravtl-Dai 21 00 000.00 2926000 33. TraveYConfaranps/7raini 0.00 4410.00 3500.00 •20.63% Ofllp fes 7 1200 621.00 6000.00 -9.38 T 10 585.00 11 00 7 000.00 38. 7, P - 217.00 250.00 300.00 20. UtlOUes 741.00 408.00 1200.00 64.77% Bui & Grounds 759.00 704.00 3610.00 33.51% Pd i PubllesUona 3 .00 435.00 100.00 -95.89% Subacri nlDueslMernharshi 35000 275.00 -21.43 hnnnnp 663.00 1000.00 0.00 -100. 17 t:Rental i Mahrhnance 1150.001 750.00 34.78% 38 Advertising 52A.001 400.00 -23.660A E Purchases-Capital Expenee 0.00 0.00 #OW/01 Professional Fees 8101.00 0.00 0.00 #Ixw01 41 ueational Materials 500.00 100.00 -80.D0% Food 8. NuMtion 0.00 0.00 #DIV/01 . . . Administrative Cosh 25,86S.00 29797.00 17,230,21 .42.1 Audit Expense .00 2,000.00 0.00% Specific Assistance to Individuals 00.00 12000.00 100.00 -90.00% OthadMiseNlaneous 165.00 175.00 6.06% 47 OtherfContiact967.00 15A21.00 16183.46 17.91 TOTAL - 285.00 498 531.00 498 SM 001 0.9% REVENUES OVERNION119M EXPENDITURES 0.00 456.00 455.001 0.22% enrmw v _ as s :Men River Cmnly H"My Sea Cw1olm H Y Far IRC PrNmm UNIFORM GRANT APPLICATION FUNDER SPECIFIC BUDGET PROGRAM EXPENSES AGENCWPROGRAM NAME: Indian River County Healthy Start Coalition/Healthy Families IRC FUNDER: IRC Children's Services Advisory Committee FY 06/07 FY 06107 % OF TOTAL FUNDER TOTAL VS. PROGRAM SPECIFIC FUNDER REQUEST BUDGET BUDGET Col. B/Col. A EXPENDITURES 21 Salaries 312,841 .00 519091 .50 16.33% 22 FICA. 23 932.33 31908.50 16.33% 23 Retirement 52000.00 0.00 0.00% 24 Life/Heaith 62,928.00 0.00 0.00% 25 Workers Compensation 2,700.00 0.00 0.00% 26 Florida Unemployment - 19400.00 0.00 0.00% 27 Travel-Daily 29,260.00 0.00 0.00% 28 Travel/Conferences/Training 31500.00 0.00 0.00% 29 Office Supplies 6,000.00 0.00 0.00% 30 Telephone 79000.00 0.00 0.00% 31 Postage/Shipping 300.D01 0.00 0.00% 32 Utilities 19200.00 0.00 0.00% 33 Occupancy Builth & Grounds 3,610.00 0.00 0.00% 34 Printing & Publications 100.00 0.00 0.00% 35 Subscription/Dues/Memberships 275.00 0.00 0.00% 36 Insurance 0.00 0.00 #DIV/01 37 E ui ment:Rental & Maintenance 750.00 0.00 0.00% 38 Advertising 400.00 0.00 0.00% 39 Equipment Pumhases:Ca itai Expense 0.00 0.00 #DIV/01 40 Professional Fees (Legal, Consulting) 0.00 0.00 #DIV/01 41 Books/Educational Materials 100.00 0.00 0.00% 42 Food & Nutrition 0.00 ' 0.D0 #DIV101 43 Administrative Costs 179230.21 0.00 0.00% 44 Audit Expense 2,000.00 0.00 0.00% 45 Specific Assistance to Individuals 100.00 0.00 0.00% 46 Other/MisceHaneous 175.00 0.00 0.00% 47 Other/Contract 189183.46 0.00 0.00% 4a TOTAL $498,985.00 $55,000.00 11 .02% s,ryzoos 84 s Y Yn FwvCMYMYIYSlalfiYb 1 MmNry FaNIigC Noprm UNIFORM GRANT APPLICATION EXPLANATION FOR VARIANCES OF 15% OR MORE TOTAL PROGRAM BUDGET AGENCYIPROGRAM NAME: Indian River County Healthy Start CoalitionlHealthy Families IRC FUNDER: IRC Children's Services Advisory Committee 4(PLANATIOKFOR VARIANCE I At A AI 1 At At 101 1 A AI A AI At Lae haakh has risen from $407/mo to $4371m; must also budgetfor 12 staff instead of 11 for the TravalZaNy The sta* raisW the travel m nbmsenrent 54% fmm .29 to 44.5 cents f mae was ncreased $50 from las[ yues $250 to $300 to cove watected costs. ftr4e costs have Increased. Manlanarce of facKe was not tacmred in last yeafs budW and is for 06-07. AI At KCBD has increased adnin costs hom 3% OD 4% for 0607 �, W5 A ab Mai River Fa, RC LO�wn i IMryFsia WL Pgym UNIFORM GRANT APPLICATION EXPLANATION FOR VARIANCES OF 159/6 OR MORE FUNDER SPECIFIC BUDGET AGENCYIPROGRAM NAME: Indian River County Healthy Start Coalition/Healthy Families IRC FUNDER: IRC Children's Services Advisory Committee LOW" E, LANA TION FOR VARIANCE lanes Salaries & FICA br this gmnt arebudgeted dre smne as the current aWm9h the gmnfwas decreased by SOCC by 10.38% MA Salaries & FICA far this gmnt are bkxlgetpd the same as the current year, alarou h the gmnt was decreased by SOCC by 10.38% JIMMI /DNA Al vrarma 35 - � ea • Indian River County Healthy Start Coalition, Inc. Healthy Families Indian River Program Children's Services Advisory Committee Gant 2006-07 J. ADDENDUM: Indian River County Children's Advisory Committee Specific Information With the exception of the Taxonomy and HF IRC Testing Materials, the following items are attached to the TLC Newborn Grant — white copies: 1 . List of Current Officers and Directors 2. IRC Healthy Start Coalition Financial Audit — Year ending June 30, 2005 3. IRC Healthy Start Coalition IRS Form 990 4. IRC Healthy Start Coalition Balance Sheet and Operating Budget 5. Staff Organizational Chart 6. 501 (c)3 IRS Exemption Letter 7. Articles of Incorporation 8. Agency Bylaws 9. Agency policy regarding Affirmative Action 10. Not for Profit Agency Certification 11 . Authorization for Release of Information 12. Nepotism Statement 13. Taxonomy Definition for Program 14. Testing Materials: Ages and Stages Questionnaire Child Developmental tool, PSI: Parenting Stress Index 14 Indian River County Healthy Stan Coalition, Inc. Healthy Families Indian River Program Children's Services Advisory Committee Grant 2006-07 13. TAXONOMY for Healthy Families IRC The taxonomy definition for the Healthy Families-IRC program falls under two taxonomies: PH- 236.240 — Family Support Centers and PH-620. 150 — Communication Training - helps parents communicate with children, health professionals and other parentlinfant interaction skills focusing on positive growth and development. 15 EXHIBIT B (From policy adopted by Indian River County Board of county Commissioners on February 19, 2002 ) " D. . Nonprofit Agency Responsibilities After Award Funding Indian River County provides funding to all nonprofit agencies on a reimbursement basis only. All reimbursable expenses must be documented by an invoice and/or a copy of the canceled check . Any expense not documented properly to the satisfaction of the Office of Management & Budget and/or the County Administrator may not be reimbursed . If an agency repeatedly fails to provide adequate documentation, this may be reported to the Board of Commissioners . In the event an agency provides inadequate documentation on a consistent basis , funding may be discontinued immediately. Additionally, this may adversely affect future funding requests. Expenditures may only be reimbursed from the fiscal year for which funding was awarded . For example, no expenditures prior to October 15' may be reimbursed with funds from the following year. Additionally, if any funds are unexpended at the end of a fiscal year, these funds are not carried over to the next year unless expressly authorized by the Board of Commissioners. All requests for reimbursement at fiscal year and (September 301h) must be submitted on a timely basis . Each year, the Office of Management and Budget will send a letter to all nonprofit agencies advising of the deadline for reimbursement requests for the fiscal year. This deadline is typicatly 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 - 8 - EXHIBIT C STANDARD TERMS FOR GRANT CONTRACT 1 . Notices . Any notice , request, demand , consent, approval , or other communication required or permitted by this Contract shall be given , or made in writing , by any of the following methods : facsimile transmission; hand delivery to the other party; delivery by commercial overnight courier service; or mailed by registered or certified mail (postage prepaid), return receipt requested at the addresses of the parties shown below: County: Brad E. Bernauer, Director Indian River County Human Services 18402 51h Street Vero Beach , Florida 32960-3365 Recipient : Indian River County Healthy Start Coalition , Inc 1603 10th Avenue Vero Beach , Florida 32960 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 - ACORD DATE (MM/DDJVYYY) TM. CERTIFICATE OF LIABILITY INSURANCE 11/0212006 PRODUCER Phone: (772) 562-3369 Fax: (772) 562-3465 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION HILB ROGAL & HOBBS OF FLORIDA, INC. - VERO BEACH ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 2045 14TH AVE. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR P O BOX 130 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. VERO BEACH FL 32961 INSURERS AFFORDING COVERAGE NAIC # I INSURED INSURER A: AUTO-OWNERS INSURANCE COMPANY __ I INDIAN RIVER COUNTY HEALTHY START, INC. INSURER 8: HARTFORD UNDERWRITERS INSURANCE COMPANY 1603 10TH AVE. - -- - - - VERO BEACH FL 32960 INSURER C: UNITED STATES LIABILITY INSURANCE COMPANY INSURER D: INSURER E COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICYPERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALLTHE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CI-AIMS. MSR NDP LTR JA TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS GATE MMD DATE MMIDDM' GENERAL unnelUTv ND01005544G 08108/06 08108107 EACH OCCURRENCE_ _ _ `$ _ _ 1 ,00.0000 COMMERCIAL GENERAL LIABILITY '1 DAMAGE TO RENTED " PREMISES CE. o«�recel $ 50,000 OGEWL CLAIMS MADE _] OCCUR MED. EXP (Anyone person) g 5,000 CPERSONAL & ADV INJURY S 1 ,000,000 GENERAL AGGREGATE 1� :jij ,600'000 1 ,000,000 AGGREGATE LIMIT APPLIES PER' S PRODUCTS-COMPIOP AGG. PRO- POLICY JECT LOC — - - AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ ALL OWNED AUTOS - - -- BODILY INJURY ~ SCHEDULED AUTOS (Per person) i $ iI BODILY aouideINJURY t) HIREDAUTOS I II NON-OWNED AUTOS leer ccltlan ) � $ - - - ._ PROPERTYDAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLV - EA ACCIDENT 11 ANY AUTO ' $ - - - El OTHER THAN EA ACC I AUTO ONLY. AGG_F EXCESS / UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ - $ WORKERS COMPENSATION AND + WC 5TATu .1Y1'EC 007700 05103/06 05/03107 rL �GHTORY LIMITS ccIDE OT&ER BANY PROPRIETORIPARTNERE ECUTIVE NT S 100,000 ICEWMEMBEREXCLUDE07E-EA EMPLOYEE $ 100,000 Xyn, ALM vlWv SPECIALMiovlSlOrvs Irolew ' E-POLICY LIMIT $ 500,000 OTHER: DIRECTORS AND OFFICERS C ND01005644G 08/08106 08/08107 : $1 ,000,000 I DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS CERITIFICATE HOLDER NAMED AS AN ADDITIONAL INSURED WITH RESPECTS TO GENERAL LIABILITY AS PER POLICY FORM AND PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, INDIAN RIVER COUNTY ITS AGENTS OR REPRESENTATIVES. 1840 25TH STREET AUTHORIZED REPRESENTATIVE VERO BEACH FL 32960 �s Attention: 978-1798 MARIANNE MASTERSON Idney a afi c��,0�4 ACORD 26 (2001 /08) Certificate # 99876 © ACORD CORPORATION 1988 _, surance L;orporation wURKERS COMPENSATION EMPLOYERS LIABILITY 47 INSURANCE POLICY-INFORMATION PAGE �; FL 34232-0303 Policy Number Policy Period To From % ` WCX 0014034 10 / 03 / 2006 10 / 03 / 200 -7 12:01 A M 8[antlartl T me et [M1e 0escnbM location RENEWAL DECLARATION Transaction RenewaHRewrite of policy No . t W DIRECT BILL CX 0014034 � . Named insured and Address KIDS CONNECTED BY DESIGN INCAgent 117 ATLANTIC AVENUE BRAISHFIELD FL FT PIERCE FL 34950 5955 T G LEE BLVD STE 200 ORLANDO FL 32822 - 4423 Telephone: 407 - 625 - 9911 0002244 Carrier A FEIN 77 13714 Risk ID ar Entity of Insured 650948854 091423537 CORPORATION Additional Locations: See Site Location Schedule 2 The Policy Period is froml0 / 03 / 2006to10 / 03 /200712 : 01 a . m . Standard Time at the Insured 's mailing address . 3 . A. Workers Compensation Insurance: Part ONE of the policy applies to the Workers Compensation Law of the states listed here: FL B . Employers Liability Insurance: Part TWO of the policy applies to work in each state listed in Item 3A . The limits of our liability under Part TWO are : Bodily Injury by Accident $ 100 , 000 each accident Bodily Injury by Disease $ 500 , 000 Bodily Injury by Disease $ 1Policy limit 00 , 000 each employee C . Other States Insurance : Part THREE of the policy applies to the states, if any, listed here: ALL STATES EXCEPT NORTH DAKOTA , OHIO , WASHINGTON , WEST VIRGINIA , WYOMING , STATES DESIGNATED IN ITEM 3 . A . D. This policy includes these endorsements and schedules: See attached schedule. 4. The premium for this policy will be determined by our Manuals of Rules , Classifications, Rates , and Rating Plans . All information required below is subject to verification and change by audit . SEE EXTENSION OF INFORMATION PAGE Minimum Premium $ 275 Total Estimated Annual Premium $ 11 , 357 Expense Constant $ 200 Premium Discount $ - 696 Deposit Premium $ 11 , 357 [:1This is a Three Year Fixed Rate Policy Premium Adjustment Period : ® Annual ; ❑ Semiannual ; ❑ Quarterly ; ❑ Monthly Countersigned this Day of Issued Date: 09 / 19 / 2006 Authorized % �- Issuing Office Sarasota , FL P $�ntativel oa SPOO1407H Ed. (09-04) YCOOD001A 105-881 INSURED COPY Page I of 4 ,tsurance Corporation WORKERS COMPENSATION EMPLOYERS LIABILITY 97' INSURANCE POLICY '-- FL 3a232-0303 Policy Number: WCX OOi 4034 Named Insured : KIDS CONNECTED BY DESIGN INC Agent: BRAISHFIELD FL 0002244 EXTENSION OF INFORMATION PAGE CLASSIFICATION OF OPERATIONS Code Premium Basis Rate Per Estimated No. Classification Description Total Est. Annual $ 100 of Annual Florida Remuneration Remuneration Premium Unit 00001 8742 SALESPERSONS , COLLECTORS OR MESSENGERS - OUTSIDE J ` 8810 CLERICAL OFFICE EMPLOYEES NOC 724 , 123 1 . 00000 {� 7 , 241 Unit Total 758 , 697 0 . 58000 Vt'� 4 , 400 9740 FOREIGN TERRORISM $ 11 , 643 9698 EXPERIENCE MDDIFICATION 1 , 4820820 0 . 03000 445 11 , 641 0 . 98000 - 233 0063 PREMIUM DISCDUNT 0900 EXPENSE CONSTANT 11 , 408 0 . 06100 - 696 State Total 200 Policy Total $ 11 , 357 $ 11 , 357 1 Issued Date: 09 / 18 / 2006 04 58001405 Ed. 102-017 WC998901 102-011 INSURED COPY Page 2 of 4 ll ; nol �nn5 11 : Gb 1rLIlbllvn HLRLIrHUL na X91 : 0Gl1 s'ia 1i : 04 1 / 1 [ 4b ! Ybd- UMp HEAL.1HY S74Rr PAGE. 0 COMMON POLICY DECLARATIONS _�OkYIN*URANCECOMPANY 9elten b Meoclatrs 7101 FOREST HILL AVENUEBox 2911 Cardinal Ortva POLICY NUMBER RICHMOND, VA 23233 Pero Sesch4api., 32964- 7498 AP509497 -- RENEWALOF NEW UnderwH ten by Colony MaxI#gemenr Services, Inc, PROGRAM CODE : — -� 1 . NAMED INSURED AND MAILING ADDRESS., PRODUCER: 09012 y KIDS CONNECTED BY DESIGN, INC. ROEHRIG & MACDUI: F (ST PETE) 117 ATLANTIC AVENUE AVE NE 1 2k 110 FORT PIERCE, FL 34950 11 1TE O A SAINT PETERSBURG , FL 33701 2, POLICY PRIRIOp: From 7 _ `, ✓ a t0 PTn512W 12:01 A . M Standard Time al Your Mailing Address above. IN RETtsW POR THC PAYMENT t1F THE PRE1411M, AAD SUalECT TOALL 07 TME TERNS OF THIS ' LICv, WE AGREE WITH YOUO T PROVp)E Tr1E INeUNANC$ A9 aTATFD IN THIS POLICY. 3. THIS POLICY CONetSTS OF THE FOLLOWING COVERAGE PARTS FOR WH)gB Aa!ApjUM IS blpiCATEO . THIS PREMIUM MAY BE SUBJECT TO ADJUSTMENT, "�"` " "" -- 111 EY. AYEt&* i4E Y irlE fip -� — COVERAGE PARTa PREMIUM COM1iERCIAL GEl\ERAi LIAFi2LI " Y C.tivERaGE' PJ PP.R1 SG . b66 . UO E1tn+a rf. u,a q (E Ms , udvv U4' �6PFLfM. !NJIRt +.,c oviartK e i r4E I .n- h N�(.YeM-�7.QIEM$�71N4.liic:4 Premitlm Charge for coverage of certified (tete of terrorism : i s (Per Policyholder Disclosure TRIA2002Notios- 1202 attached.) er Coverage fpr certified aCIa of terrorism has been rejected ; exclusion attached . (Per PORCyholder Diaciosure TRIA2002Notice- 1202 attached ) _ ISSUED 38 / 1) e12066 SG `_ Prwnlum ahowe 4 payabM at inception`-" Teta) Pottoy Pro"Oum: S 6 . 666 . 00 4. FORMS APPLICABLE TO ALL COVERAOES: InapaCtion Fea: �rV! $126.00 - feauS160 . 00 Sae Form U001 - Sc9ladu4e Of Forma anp Endorsements Tause 0354 , 95 TOTAL '17 . 180 . 95 S. BUSUNE935ESCRIPTION: SOCIAL ,SERVICrq— CASE MANACEN.EN_T CounteMpned. AV fspen[nVtllrt Wue+a«a„lyaa wa4w of huwo frvva Mrw 4<. vn « to-wrVn DCJ6660 107102) cap-�n. n.....wi sr.: ., a.a� :n . .a►. nsa. .. .. . .. NINE 11 / 0_5 / 2000 1 .1 : 08 7727781340 HEALTH"FAMILIESIRC PAGE 02 .•—.•._... .� . . — W . rp . y .�q ai [ V � 1r : : 4b ' YJ1 'i@d'. Nt:�J_ ' Nv `_ IAY, I P.iuE. (lj COMMI?RCtAL GENERAL LIABILITY COVERAGE PART DECLARATIONS This ooversge Pert consists or mis Dsclaralions corm , the Common Policy Con"Ons , ?h& Cnmmefoar Gen6raf L:ab Ory Coverage Form and IhA endorsements rtWicated es aPDliWble. POLICY NC. Ap5JB497 NAMED IN&UREU ._ cTL,s cOaNsc ; E:, a, oes�vN , n 3.LIMITS OF INSURANCE General AQgnegate Lmbl (Other Than PtadUats - Completed Overallons) ��^----�'- Products Cotmplsted OP,"bons Aggregate Limir Personal d, Advertising Ir*^ Limit 1NCLUDEc Each Ooourreno+ Limit si , uoo , o0o . co Damage To Prwniees Ranted To You Limit Medical Expense 1.1m1t SSC , OoO . 00 Any Oro Prencsas Medical Expense Aggregate Limit `%x cL=. D Any One Person FRCLUDED Ali Persons/Year I3edtrdibte Eacn Claim _ RETROACTIVE DATE (CG 00 02 oni i - Coverage A of Nus insurance does not 'ProWy damage' wMtdt 00ours before Retroactwe Date, if any, shown below. apply to tltn injury" or Retroadtive Dere 0712VY10od�_. _ (Ener Date r """'�-•._. _...__ 0 Nona% no RetroacyVir t)afe AODiiea) t.Ocauon of All Promises You own. Rent or Om" (Same s s ItHln S u.Mess shown Wow): T � � li 30 25Tx STREET POR" PIERCEc iEU:i -GTM At'g FL 349 , 0 VERO PLAC4 FL 32964 CLASSIFICATION CODE NO. PREMIUM BASISAD4ANGE nFEMI'�M ^-� NJH- WNED 6 H ?REO AUry 334 • ii215 it7CLUL�ED -•_ ��� T PR CO � qq OTHER SAGES , BBkV2C£ OR 334 . 4136E ! s ; ff 0 ..^oxg".:LTING 6ao , 2Q1 � :� . 4 'r5 . U7 �iRt3yW 2 LA7;,0145 117CLI7JZNG PRODtir^g I I 1JFD/OR CdMVLS?tt� OPE1tAT1CNG j , I i I j t a . 7L Sae 0001 - Schedule of r onns and Enoorsem FORMS / ENDORSEMENTS APPLICAOLE : ants TOTAL PREMIUM FOR THIS Ss , ce = . 00 5, FORM OF Ss: coxa 1COVDIACEPARr I oRA7 ON Audit PewdAmort x$*"Q"Nwse 9!deC' 0CJ8563AM !' saw� rm•w'tr+ ne�wwe w,..n•a uo me umr. i.,. "mrt. nsnua IC' rOZt cur~.