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2006-331Z.
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 United For Families (Recipient) , of: United For Families 10570 S . Federal Highway, Suite 301 Port St. Lucie, Florida 34996 Foster Parent Retention 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 : TWENTY THOUSAND, DOLLARS ($20,000). 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. - 3 - IN WITNESS WHEREOF , County and Recipient have entered into this Contract on the date first above written . INDIAN RIVER COUNTY BOARD OF COMMISSIONERS Gary„C .- u a r Chairman BCC Approved; -I 10 103 Attest: J . K Barton, Clerk r n By: Deputy Clerk Approved : N Jose h A. Baird County Administrator Approve as to form and legal sufficiency: Ilk n � By: ; Marian E . Fell , ist nt County Attorney RECIPIENT : By: ick��— United for Families - 4 - EXHIBIT A (Copy of complete Request for Proposal) EXHIBIT - A - United for Families, Foster Parent Mentor Program, Children's Services Advisory Committee �J � ` q _ PROGRAM COVER PAGE Organization Name: United for Families Executive Director: Christine Demetriades E-mail : Christine.demetriadesnuff.us / Address : 10570 S. Federal Hwy. Ste. 301 Telephone : (772) 398-2920 Port St. Lucie, FL 34996 Fax: (772) 398-2920 Program Director: 011ie Harvey E-mail : ollie.harvey&a uffus Address : 10570 S . Federal Hwy. Ste 301 Telephone : (772) 398-2920 Port St. Lucie, FL 34996 Fax: (772) 398-2925 Program Title: Foster Parent Mentor and Retention Program; Taxonomy Code : PH- 140. 500 Priority Need Area Addressed: The support of those in need of special assistance �e Brief Description of the Program: Recognizing that veteran foster parents are the best resource for new�— foster parents, UFF will create a mentoring program to educate foster parents about local resources and how to access them, to facilitate retention of foster homes and to decrease the number of disruptions in child placements. UFF will hire one qualified foster parent to serve as a mentor in Indian River County. The Mentor will help foster parents troubleshoot problems in the system and help direct foster parents to community resources. The mentor will attend all Foster Parent Association and Shared Services Alliance of Okeechobee and the Treasure Coast meetings and meet regularly with a foster parent coordinator. This coordinator will train and oversee mentors as well as re-license foster parents. The coordinator will work with the mentor team to lead the county in foster-parent retention activities, such as an annual Foster Parent Appreciation Dinner. SUMMARY REPORT — (Enter Information In The Black Cells Only) Amount Requested from Funder for 2006 /07 : $ 20 , 910 Total Proposed Program Budget for 2006 /07 : $ 25 ,291 Percent of Total Program Budget : 82 . 7 % Current Program Funding ( 2004 / 05 ) : $ _ Dollar increase /( decrease ) in request : $ 20 , 910 Percent increase /( decrease ) in request * * # DIV /0 ! Unduplicated Number of Children to be served Individually : 77 Unduplicated Number of Adults to be served Individually : 46 Unduplicated Number to be served via Group settings : Total Program Cost per Client : 205 . 62 * *If request increased 5% or more, briefly explain why: New Program If these funds are being used to match another source, name the source and the $ amount: N/A The Organization 's Board ofDirectors has approved this applicano date). �.DVtsOCCtah2 ( � Name of President/Chair of the Board Sign e 0, risine W • 1eme+T modes `NNaNme of Executive Director/CEO Signature / Zo` 124 United for Families, Foster Parent Mentor Prograrn, Children's services Advisory Committee ORGANIZATION: United for Families PROGRAM: Foster Parent Mentor Proeram TABLE OF CONTENTS "X" theparts ofgrant application to indicate inclusion. Also, please put page number where the information can be located. 1XI Section of the Proposal Pa e # COVER PAGE (with signatures) TABLE OF CONTENTS (check list) A. ORGANIZATION CAPABILITY (one page maximum) 1 . Mission and Vision of organization. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 2. Summary of expertise, accomplishments, and population served . . . . . . . . . . . . . . . . 1 B. PROGRAM NEED STATEMENT (one page maximum) 1 . Program Need Statement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 2. Programs that address need and gaps in service . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 C. PROGRAM DESCRIPTION (two pages maximum) 1 . Funding priority . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 2 . Description of program activities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 3 . Evidence that program strategy will work. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 4. Staffing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 5 . Awareness of program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 6. Accessibility of program. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 D. MEASURABLE OUTCOMES (two pages maximum) . . . . . . . . . . . . . . . . . . . . . . . . . 5 E. COLLABORATION (one page maximum) . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . 0 . . . . . . . . . 9 F. PROGRAM EVALUATION (two pages maximum) 1 . Demographics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 2 . Measures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 3 . Reporting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 G. TIMETABLE (one page maximum) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 . . . . . . . . . 12 H. UNDUPLICATED CLIENT COUNT 1 . Projections by Location . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 . . . . . . . 13 2. Projections by Age Group . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 1. BUDGET FORMS 1 . Financial Budget Forms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B1 -134 United for Families, Foster Parent Mentor Program, Children's Services Advisory Committee J. FUNDER SPECIFIC/ADDITIONAL SHEETS K. APPENDIX ✓ List of current officers and directors Financial audit with management letter IRS Form 990 Financial statement Org. chart Annual report i 501 c (3) ci Articles of incorporation Bylaws i Affirmative action policy Nepotism statement / Taxonomy / Disclosure of relationships i Agency certification Testing materials/measurement materials United for Families, Foster Parent Mentor Program, Children's Services Advisory Committee PROPOSAL NARRATIVE A. ORGANIZATION CAPABILITY (Entire Section A not to exceed one page) 1 . Provide the mission statement and vision of your organization. United for Families ' mission is to help end the cycle of child abuse through a diverse network of community providers and innovative services. We were created in 2003 in response to Community Based Care, a statewide initiative that privatized public child welfare services. We are a non-profit agency charged with developing local services and supports for children and families in Okeechobee and the Treasure Coast. Our commitment to the community is to ensure safety to all children and to provide permanent homes for them. We envision a community where the safety and well-being of children is the concern of every individual; where "Safe Place" is not just a sign on a door, but a creed in every home. We believe that every child deserves a healthy family, and that every weakened family deserves a chance to heal itself. UFF will lead the community in the pursuit of these ideals. 2. Provide a brief summary of your organization including areas of expertise, accomplishments, and population served. UFF is the local umbrella agency in child protective services. We believe that the best way to respond to our community' s unique needs is to bring all local providers of child-abuse services to a single table and to take advantage of existing resources. The services are provided by agencies such as Children' s Home Society and Exchange Club CASTLE, but the design and payment of those services and the children they target are completely the responsibility of UFF. By choosing to provide services through partner agencies, we believe we have fully embraced the true spirit of community based care. For example, UFF recognized the need for greater recruitment efforts to increase the number of licensed foster homes . We developed a program to address that need and, using state and federal grant dollars, hired Hibiscus Children' s Center to provide the service. Our network of providers and the services we entrust to them is comprehensive. Children and families in St. Lucie, Indian River, Martin and Okeechobee counties have access to services that include: Domestic violence and substance abuse prevention, housing assistance, foster care and adoption, family support services, individual and group counseling and behavior management. Since our incorporation in 2003 , we have decreased the length of time children are removed from their homes from 18 months to less than a year. We found more adoptive homes for children than all but one region of the state. Most important, UFF ranked third in the state for keeping children out of the system once they returned home. This indicates that parent-education programs — created to prevent the re-abuse of children — are working. Furthermore, UFF accomplished these tasks with nearly half the funding per child as our sister agencies in South Florida ($8,000 per child locally compared to $ 15,382 per child in Palm Beach County) . 1 United for Families, Foster Parent Mentor Program, Children's services Advisory Committee B. PROGRAM NEED STATEMENT (Entire Section B not to exceed one page) 1 . a) What is the unacceptable condition requiring change? b) Who has the need? c) Where do they live? d) Provide local, state, or national trend data, with reference source, that corroborates that this is an area of need. A lack of support services threatens the stability of the foster care system because foster parents who do not feel supported are more likely to quit. UFF strongly believes that in-home support dedicated to the needs of foster parents is the best way to improve foster parent retention. An efficient child-welfare system that provides safe and temporary shelter to children for the least amount of time necessary depends on its ability to successfully recruit and retain foster parents. We currently license23 foster homes in Indian River County, of which 19 actively take children. Of those active homes, 14 are at or above capacity, meaning we cannot use those homes to place other children. Because only 22 percent of Indian River County homes currently have beds available, 30 percent (47) of Indian River County children who have been removed from their homes live in shelters or in other parts of the state. Not only does this remove a child from familiar settings, it also hinders the reunification process and lowers the probability that the child will return home, (Petr and Entriken, 1995, Service System Barriers to Reunification, Families in Society, 76(9) 523-533). d The No. 1 reason that caregivers leave foster care is lack of support, according to the 2002 National Conference of State Legislators report, Supporting and Retaining Foster Parents. The same report specified the type of support needed as "support from child welfare agency, including adequate supervision, monitoring and consultation, as well as support from a network of other foster parents." These trends are reflected in local exit interviews of former foster parents. An evaluation of 2005 re-licensing data suggests nearly 34 percent of UFF foster parents who did not renew their license opted out of the system due to a lack of support. Lack of support is exacerbated by a poor financial outlook among foster parents, whose mean annual household income is $37,429 (state average is $38, 819). The average foster home in Florida receives about $369 a month to care for a foster child, making Indian River County foster parents among the least reimbursed in the nation. According to a May 2004 USDA report, "Expenditures on Children by Families; 2003 ," childcare costs for a three-child home with teen- agers equal about $23 ,640 annually. That cost, when divided per child over 12 months, is $657 a month, or $288 more than the stipend Florida foster parents receive to care for a child. The need for better foster-parent support exists throughout the state, and at least two other districts — including the Daytona and Lakeland areas — have implemented similar mentor programs to address it. 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. UFF contracts case management services to Children' s Home Society and Family Preservation Services. Both agencies indirectly serve foster parents through the case- management of children on their caseloads . The needs of foster parents, however, often go unaddressed in the daily struggle to deal with child-related issues. Hibiscus Children' s Center also serves foster parents through UFF recruitment and training program. These services, however, end once the foster parent is licensed. 2 United for Families, Foster Parent Mentor Program, Children's Services Advisory Committee C. PROGRAM DESCRIPTION (Entire Section C, 1 — 6, not to exceed two pages) 1 . List Priority Needs area addressed, The support of those in need of special assistance. 2. Briefly describe program activities including location of services. The program objective is to retain foster parents in Indian River County and decrease the number of disruptions to local foster children. To achieve this, UFF will hire one Indian River County mentor from a pool of qualified, veteran foster parents. The mentor will receive $500 monthly in return for offering group and in-home support to new foster parents. The mentor will receive 15 hours of Certified Behavior Analyst training. The Department of Children and Families will provide the training at UFF headquarters in Port St. Lucie. A foster parent coordinator will oversee the program, supervise mentors and provide additional training that will help mentors identify local resources. Children' s Services Advisory Committee funding will be used to fund this position. Each mentor will be expected to attend all Alliance and Foster Parent Association meetings, assist in the training of new foster parents and meet regularly with the foster parent coordinator. In Indian River County, group activities will take place at the UFF location in Vero Beach or at UFF headquarters in Port St. Lucie, while in-home services will be provided throughout the county. The mentor will be assigned to new foster parents as they are licensed. They will assist in troubleshooting problems, identifying and coordinating community resources, and guiding foster parents through the system. They will serve the general foster care community in the same fashion. Some of the questions mentors might address include: • Why isn't my foster child responding to the discipline techniques I learned in training? • How do I relate to my foster child' s biological parents, and how much interaction should I have with them? • My foster teen-ager thinks she' s in charge of her siblings — How do I make her understand her new role as child and not caregiver? Mentors will monitor all phone calls and record all activity with foster parents. The foster parent coordinator will file reports of all activity, track problems and requests and monitor mentor responsiveness and overall program success. Mentors will be available to all foster parents for the duration of their service. Exit interviews with foster parents who leave the system will indicate program responsiveness. 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. The number of foster homes recruited each year is not enough to make up for the homes that decline re-licensing. Though the reasons foster parents leave the system vary from home to home, there is one universal indicator: 3 United for Families, Foster Parent Mentor Program, Children's Services Advisory Committee "Lack of support is the biggest reason foster parents leave the system," Foster Parent David Hall said in an Apr.127, 2006 interview. "We' re trained how to deal with children' s behaviors one way, but in reality, there ' s nothing you learned that can help you deal with those problems. " Hall' s assessment is backed by a 2005 UFF data report that suggests 34 percent of home closures were due in some part to lack of support. Those closures represent a loss of up to 36 beds that could have been given to children. An annual foster parent appreciation dinner also is planned as part of the program and will offer another avenue for retention activities. Studies show that recognition and praise is instrumental to successfully engage any type of volunteer activity. UFF drew from conclusions of the 2000 Governor s Blue Ribbon Panel for Foster Care Recruitment and Retention in designing this program. The study, which engaged foster parents from throughout Florida, found that the key to improving recruitment and retention is to increase both financial and non-financial support to existing foster parents . Peer mentors were specifically named as a best practice in foster parent retention. 4. List staffing needed for your program, including required experience and estimated hours per week in program for each staff member and/or volunteers (this section should conform to the information in the Position Listing on the Budget Narrative Worksheet). • Foster Parent Coordinator: Coordinator will have experience working with foster parents and in accessing local resources . The coordinator will serve approximately 40 hours per week and be expected to attend all monthly foster parent association meetings. • Mentor: The mentor must be a foster parent who resides in Indian River County and who has at least three years of experience. Mentor will serve at least 10 hours per month. 5. How will the target population be made aware of the program? The UFF foster parent coordinator will assign mentors to new foster homes during the licensing process. UFF will make the program available to the foster care community in general and increase awareness of the program through a monthly newsletter and during monthly foster parent association meetings. The program will be incorporated in all foster parent training courses, and case managers will about learn the program through required pre-service training. 6. How will the program be accessible to target population (i.e., location, transportation, hours of operation)? The mentor will make home visits when necessary and be accessible 24 hours a day, all week. The mentor also will be available during monthly foster parent association meetings, which take place in Vero Beach, or by phone. Problems arising at night that require the coordinator or any other UFF staff will be handled at the start of the next business day. After- hour emergencies, however, will be handled via an on-call worker. 4 United for Families, Foster Parent Mentor Program, Children's services Advisory Committee D . MEASURABLE OUTCOMES (Entire Section D not to exceed two pages for each year) OUTCOMES RESULTS List all ofthe elementsfor the Measurable Outcome(s) or theprevious 12-monthperiod. N/A N/A 5 United for Families, Foster Parent Mentor Program, Children's Services Advisory Committee OUTCOMES RESULTS List all ofthe elements for the Measurable Outcome(s) or the previous 12-month period N/A N/A 6 United for Families, Foster Parent Mentor Program, Children's Services Advisory Committee OUTCOMES ACTIVITIES Add all of the elements for our Measurable Outcome(s) List the tasks to accomplish the Outcome(s) To decrease the number of disruptions to Assign a mentor to every new foster parent and Indian River County child placements by 25 establish regular contact, prepare resource percent in one year as reported by 2006 UFF guide and newsletter to keep parents engaged, placement records. Baseline: 2005 placement report all activity and follow up on and disruption records ( 12 children) . problems/issues previously identified. To decrease by 30 percent the number of Provide in-home support and resource Indian River County foster parents who rescind education to foster parents, coordinate their licenses following a year in the program retention activities including annual as reported by 2006 re-licensing reports. appreciation event, and follow up on all Baseline : 2005 re-licensing reports (7 identified issues. closures). Increase by 50 percent the number of Indian Increase awareness of meetings through River County foster parents who attend mentors, report upcoming meeting dates, times monthly Foster Parent Association meetings as and locations in monthly newsletter, offer reported by monthly sign-in sheets. Baseline : incentives to attend meetings, such as 2005 attendance average ( 10 parents) . toiletries, school supplies and other community resources. 7 United for Farnilies, Foster Parent Mentor Program, Children's Services Advisory Committee OUTCOMES ACTIVITIES Add all of the elements or our Measurable Outcome(s) List the tasks to accomplish the Outcome(s) 8 United for Families, Foster Parent Mentor Program, Children's services Advisory Committee E. COLLABORATION (Entire Section E not to exceed one page) 1 . List your program' s collaborative partners and the resources that they are providing to the program beyond referrals and support. (See individual funder requirements for inclusion of collaborative a reement letters.) Collaborative Agency Resources provided to the program Hibiscus Children' s Center Program inclusion as part of foster-parent trainings Department of Children and Families Certified Behavior Analyst training of mentors and use of building for foster parent meetings St. Lucie County Foster Parent Identification of possible mentors; assistance in program Association activities Martin County Foster Parent Identification of possible mentors; assistance in program Association activities Indian River County Foster Parent Identification of possible mentors; assistance in program Association activities Children' s Home Society Program inclusion in case-management pre-service trainings Use of school for FPA meetings Indian River County School Board 9 United for Families, Foster Parent Mentor Program, Children's Services Advisory Committee F. PROGRAM EVALUATION (Entire Section F not to exceed two pages) 1 . DEMOGRAPHICS : What information (data elements) will you need to collect in order to accurately describe your target population including demographics (age, gender, and ethnic background) required by the funder in Section H? What are the pieces of information that qualify them for your target population? How do you document their need for services or their "unacceptable condition requiring change" from Section Bl ? UFF will capture the following information through program-specific spreadsheets : foster parent name, initial licensure, number of children foster parent is licensed to serve, children in home, length of stay for each child, number of disruptions, reason for disruptions. All foster parents are entitled to the services provided by mentors . However, mentors will target parents licensed within a year of program start. 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? UFF will assess the number of homes seeking re-licensure, as well as the total increase in homes in a year. The foster parent coordinator also will gauge on a monthly basis the number of times a child is removed from a home due to foster parent inexperience or lack of support in sustaining the placement. We will collect these data elements through licensing reports, yearly retention records and re-licensing reports. Disruptions will be measured with UFF placement reports. Baseline information will come from UFF, which oversees all foster-child placement activity, and Hibiscus Children' s Center, which retains records for foster-parent recruitment and retention. All activities will be recorded by mentors and reported to the foster parent coordinator, who will review the reports on a monthly basis. Baseline comparisons will be reviewed quarterly. Finally, foster parents will be surveyed at the 6-month point to ensure that the population is aware of the program and that the program is being met with enthusiasm. The survey also will ask for any suggested changes. A follow up survey will be given at the end of the first 12-month period. 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 foster parent coordinator will compile all data in an annual report and present it to the Director of Development, who will make sure the program is meeting outcomes and goals . The 10 United for Fmilies, Foster Parent Mentor Prograrn, Children's services Advisory Committee report will be presented to the IRC Children' s Services Advisory Committee during its annual review of funded programs. All outcomes will be presented to the Board of Directors and to the Alliance and reported in the monthly UFF newsletter. UFF will use the report to gauge overall program success and to evaluate whether any changes should be made, including possible new activities or collaborative partners that could help make the program more successful. While the report will be annual, UFF will evaluate the program monthly throughout its first year and make needed changes to ensure program success by the end of the year. All information will be shared with mentors and the foster parent population. 11 United for Families, Foster Parent Mentor Program, Children's services Advisory Committee G. TIDIETABLE (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 Pre-program Hire Foster Parent Coordinator Meet with Foster Parent Association Presidents to discuss program design and mentor responsibilities Mentor interviews July 2006 Hire Mentors August CBA training September Assign mentors to foster parents/ begin monthly phone logs/visits October Quarterly program review/ monthly phone logs/visits November Monthly phone logs/visits December Monthly phone logs/visits January Quarterly program review/outcomes evaluation/monthly phone logs/visits February Monthly phone logs/visits March Monthly phone logs/visits April Quarterly program review/ monthly phone logs/visits May Monthly phone logs/visits/annual recognition dinner June Monthly phone logs/visits July 2007 Annual program review/ monthly phone logs/visits 12 Number of Unduplicated Clients by Location , • _. Current Fiscal Yeara ILLLLL: 1 11 11 • * II Budget 2005/06 ' 1 1 f Ile 1 I of IT, 1 1 11FIRIPPRIM, M111EM11MIRM, 1 I Li I No . . inPRIA it , . . BeachJensen • • ORMEM WIN = • I • 1 1 1 Number of Unduplicated Clients by • ' 1 MINES= In • 1 ������ United for Families Foster Parent Mentor 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. AGENCYIPROGRAM NAME : United for Families FUNDER : CSAC . . _ . . _ . . _ . . _ . . _ . . _ . . _ . . - - - - - - - . . _ . . - - - - - - - - . _ . . . . . . . . . . . . . . _ . . . . . . . . . . . _ . . _ . . — . . . . . . . . . . . . . . ! CAUTION : Do not enter any figures where a cell is colored in dark blue - Formulas and/or links are in place. Gray areas should I Abe used for calculations and to write information only. ` ONAYM eVK Proposed Total Program ' Funder.Spec�c Total Agency ' . REVENUES AOENCYUSEONLY �LJuT1ON8) Budget Budget Budget 1 Children's Services Council-St Lucie 36,000.00 2 Children's Services Council-Martin 3 Advisory Committee-Indian River 20,909.88 20,909.88 4 United Way3t Lucie County 5 United Way-Martin County 6 United Way-Indian River County 7 Department of Children & Families 1 18,893,994.00 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 337,000.00 18 Reserve Funds Used for Operating 19 In-Kind Donations (Not Included in total) 4,380.88 20 TOTAL REVENUES (doesn't include line 19) $20,909.881 $20,909.88 $19,266,994.00 ,. A B C D . EXPENDITURES GRAY ARE FOR Proposed Total Program Funder Specific Total Agency AOENCYUSEONLY RHOWOALCULAT01461 .'Budget . Budget Budget 21 Salaries - (must complete chart on next page) 8,526.00 8,400.00 1 ,376,522.00 Salary 21 % foster care coordinator and d % supervisor 22 FICA - Total salaries x 0.0765 7.65% 652.24 642.601 406,209.00 Retirement - nnua pension tor qualle 23 staff 341 .04 336.00 0.00 Life/Health - Medical/Dental/Short-term 24 Disab. 852.60 840.00 0. 00 Workers Compensation - # employees x 25 rate 511 .56 504.00 0.00 Florida nemp oymen - 9 projected 26 employees x $7,000 x UCT-6 rate - 341 .041 336.00 0.00 SALARIES A B D POSITION LISTING Gross Annual Portion of salary on Proposed C % of Gross Annual '.. Salary Program Funder Specific Budget Salary Position Titfe / Total Hrs/wk (Agency) Program Example: Executive Direcror140hm 70,000.00 (0,000.00 5,000-00 519/2006 a-t United for Families Foster Parent Menta Foster Care Coordinator 40,000.00 8,400.00 8,400.00 21 .00% Supervisor 60,000.00 126.00 0.60 0.00% #DIV/0! #DIVIO! #DIV/D! #DIV/0! #DIV/0! #DIV/0! #DIV/O! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/o! #DIV/0! #DIV/0! Total Remaining Agency Salaries 1 ,276,522.00 0.00% #DIV/01 Remaining positions throughout the agency Total Salaries $1 ,376.522.00 $8,526.00 $8,400.00 0.61 FRINGE BENEFITS DETAIL A (Funder Specific Budget Funder B c n e F c Position Pension Worker's Unemployme Total Fringes Funder i lelonly, from Ilse 22 t0 27 Speck FICA Z65% Health Ins. � ' Budget - (Ax %) Compens. dt Comperts. Speck Position Tide / Total Hrs/wk Example: Case Manager/40 hia 50000.00 382.50 - 200.00 ` 500.00 300.00 200.00 11582.50 Foster Care Coordinator 8,400.00 642.60 336.00 840.00 504.00 336.00 2,658.6 Supervisor 0.00 0.00 0.00 0 0.00 0.00 0.0 0 0.60 0.00 0.06 0 0.00 0.00 0.0 0 0.00 0.00 0.6 0 0.00 0.00 0.0 0 6.00 0.00 0.0 0 0.00 0.00 0.00 0 0.00 0.00 0.00 0 0.00 0.00 D.Do 0 0.06 0.00 0.00 6 0.00 0.00 0.0 0 0.00 0.00 0.0 0 MID 6.00 0.00 0 0.00 0.00 0.00 0 0.00 0.00 0.00 6 6.00 0.00 0.00 Total Remaining Agency Salaries 1 0.001 0. 001 1 0.00 0 1 O.D01 0.001 0.0 Total Funder Request Fringe Benefits 1 $8,400.001 $642.601 $336.001 $840.001 $504.001 $336.00 $2,658.60 A B C D ' EXPENDITURES R ;fix FOR Proposed Total Program Funder Sp f, Total Agency eagw Demi Budget Budg 7Budget 27 Travel-Dairy 1 ,827.00 1 ,827.00 21 ,000.00 At of Staff x average # of miles/wk x 50 wks x $ = Estimated Daily Travel/Mileage Reimb. 390 miles/mo X .39 for t . mentor 28 Travel/Conferences/Training 210.00 - 0.00 159,413.00 s Mow a-t United for Families Foster Parent Mellor • National Conference (cost per staff) 40 hours CBC salary X 21 % (IRC • Training/Seminar (cost per staff) Foster Parent Mentor program is 21 % • Other Trainings (cost of travel, lodging, of total program cost to UFF in four registration, food) counties) 29 Office Supplies 29,004.00 • Office supplies (monthly average x 12 months = estimated cost of office supplies based on present history. 30 Telephone 1 , 034.001 264.00 115,004.00 # Phone lines x average cost per month x 12 months = local phone cost • Average long distance calls x 12 months = Estimated cost of long distance t line at $22/mo 31 Postage/Shipping 107.64 107.64 9,996.00 • Quarterly Mailing of Newsletter • Special events, etc, monthly newsletter to 23 homes at .39 • Bulk mailings - appeals each - 32 Utilities • Electricity ($ x 12 months) • Water/Sewer ($ x 12 months) • Garbage ($ x 12 months) 33 Occupancy (Building & Grounds) 3,235.00 0.00 559,521 .00 • Mortgage/Rent ($ x 12 months) - • Janitorial ($ x 12 months) • Grounds Maint ($ x 12 months) 21 % of occupancy @ 1 ,283.75/month • Real Estate Taxes based on square footage 34 Printing & Publications 107.64 107.64 10,004.00 • Quarterly Newsletter ($ x 4) • Letterheads, Envelopes, etc. • Fundraising materials • Other .39 per color newsletter for 23 homes 35 Subscription/Dues/Memberships • Membership to National Organization • Dues • Subscriptions to Newspapers/magazines, etc. 36 Insurance 20,816.00 • Directors/Officers Liab. • Commercial/General Insurance • Bond Ins. • Auto Insurance 37 Equipment: Rental & Maintenance 70,604.00 • Copier lease ($ x 12 months) • Meter lease ($ x 12 months) • Copier Maintenance ($ x 12 months) • Computer Maintenance ( $ x 12 months) • Other 38 Advertising • Newspaper ads • Fundraising ads/promotions • Other (vacancies) - 39 Equipment Purchases:Capital Expense • Computer/monitor (# x $) • Laser Printer 40 Professional Fees (Legal, Consulting) 37,992.00 • Legal advice ( estimated #hrs x $) • Consultant fees - • Other 41 BooksfEducational Materials • Books/videos Materials ($ x staff) 42 Food & Nutrition 5/9/2006 B-1 United for Families Foster Parent Mentor • Meals ( # meals x clients x 5days x 50 wks) • Snacks 43 Administrative Costs 495.00 495.00 99,496.00 includes recruiting and training of case management and foster • Admin. Cost (% of total budget) 2% total budget parents 44 Audit Expense 348,911 .00 • Independent Audit Review 45 Specific Assistance to Individuals 7,729,484.00 • Medical assistance • Meals/Food • Rent Assistance • Other 46 Other/Miscellaneous 1 ,050.00 1 ,050.00 • Background checkidrug test Annual Foster Parent Appreciation • Other (21 % of district cost) 47 Other/Contract 6,000.00 6,000.00 8,273,018.00 • Sub-contract for program services $500 monthly stipend for mentor 48 TOTAL EXPENSES $25,290.76 $20,909.88 $19,266,994.00 51912006 B-1 FU P mnl ManWl P,Wam UNIFORM GRANT APPLICATION TOTAL AGENCY BUDGET AGENCYIPROGRAM NAME: United for Families/ Foster Parent Mentor Pro ram FY 04/05 FY 05/06 FY 06107 % INCREASE FYE FYE FYE CURRENT VS. NEXT FY BUDGET A B C D ACTUAL TOTAL PROPOSED (col. Csol. Bycol. 3 REVENUES BUDGETED BUDGETED 1 Children's Services Council-St Lucie 3fi 0011.00 36,000.00 36,000.00 0.00% 2 Children's Services Council-Martin 0.00 #DIVIO! 3 Advisory Committee-Indian River 0.00 #DIVI01 4 United Way-St Lucie County 0.00 #DIV/01 5 United Way-Martin County 0.00 W1viol 6 United Way-Indian River County 0.00 #DIV/01 7 Department of Children & Families 16 221,717.00 18,893 994.00 18,893,994700 0.00% a County Funds 0.00 #DIVI01 9 Contributions-Cash 18 294.00 0.00 #DIV/01 to Program Fees 0.00 #DIV/OI 11 Fund Raising Events-Net 0.00 #DIVI01 t2 Sales to Public-Net 0.00 0DIV101 13 Membership Dues 0.00 #DIV/0! 14 Investment income 0.00 #DIV/01 15 Miscellaneous 133,468.00 0.00 #DIV/01 16 Legacies & Bequests 0.00 #DIV/01 17 Funds from Other Sources 22p255.00 377',00000 337,000.00 0.00% is Reserve Funds Used for Operating 0.00 #DIV101 191n-Kind Donations (Nut ncly din lora) 0.00 #DIV/01 20 TOTAL 16 431 734.00 19,266 994.00 19,266,994.00 0.00% EXPENDITURES 21 Salaries 918 228.00 1 376 522.00 1,376,522.00 0.00% 22 FICA 393,526.00 406,209.00 406,209.00 0.00% 23 Retirement 0.00 #DIV101 24 Life/Health 0.00 #DIV/01 25 Workers Compensation 0.00 #DIV/01 26 Florida Unemployment 0.00 #DIVI01 27 Travel-Dail 523,023,00 ' 21 000.00 21,000.00 0.00% za TravellConferences/Treinin 159,413.00 159,413.00 0.00% 29 Office Supplies 29 004.00 29 004.00 0.00% 3o Telephone 115,004.00 115,004.011 0.00% 31 Postage/Shipping 9,996.00 9,996.00 0.00% 32 Utilities 0.00 #DIV/01 33 ;Occupancy (Building & Grounds 157 880.00 559,521 .00 559,521 .00 0.00% 34 Printing & Publications 10,004.00 10,004.00 0.D0% 35 Subscription/Dues/Memberships 0.00 #DIVI01 36 Insurance 42 479.00 2081600 20,816.00 0.00% 37 E ui ment:Rental & Maintenance 70 604.00 70,604.00 0.00% 39 Advertising 0.00 #DIV101 39 Equipment Purchases:Ca ital Expense 11,051.00 0.00 #DIVIOI 40 Professional Fees (Legal, Consulting) 65,799.00 37992.00 37,992.00 0.00016 41 Books/Educational Materials 0.00 #DIV/01 42 Food & Nutrition 0.00 #DIV/O! 43 Administrative Costs 99,496.00 99,496.00 0.00% 44 Audit Expense 348y911.00 348 911 .00 0.00% 45 Specific Assistance to Individuals 14,302 902.00 7,729 484.00 7,729,484.00 0.00% 46 Other/Miscellaneous 0.00 #DIV/01 47 Other/Contract 8,273,018.00 8 273 018.01) 0.00% 4s TOTAL 16,414,868.00 19,266,994.00 19,266,994.00 0.00% 4s REVENUES OVER/ UNDER EXPENDITURES 16,846.00 0.00 0.00 #DIV/01 sarzooe ez Um mF. Faw P..ew,m,P� UNIFORM GRANT APPLICATION TOTAL PROGRAM BUDGET AGENCYIPROGRAM NAME: United for Families/Foster Parent Mentor Program FY 04/05 FY 05106 FY 06107 % INCREASE FYE FYE FYE CURRENTVS. NEXT FY BUDGET A B C D ACTUAL TOTAL PROPOSED (W. Ccal. SycoLB REVENUES BUDGETED BUDGETED I Children's Services Council-St. Lucie 0.00 #DIV/DI 2 Children's Services Council-Martin 0.00 #DIVIOI 3 Advisory Committee-Indian River 0.00 0.00 20,909.68 #DIV/0! 4 United Way-St Lucie County 0.00 #DIVI01 5 United Way-Martin County 0.00 #DlVlol 6 United Way-Indian River County 0.00 #DIVIOI 7 Department of Children & Families 0.00 #DIV/01 a County Funds 0.00 #DIVIOI 9 Contributions-Cash 0.00 #DIVIOI 10 Program Fees 0.00 #DIVIOI 11 Fund Raising Events-Net 0.00 #DIV/01 12 Sales to Public-Net 0.00 #DIV/O! 13 Membemhi Dues 0.00 #DIVI01 14 Investment Income 0.00 #DIVI01 15 Miscellaneous 0.00 #DIV/01 16 Legacies & Bequests 0.00 #DIVI01 17 Funds from Other Sources D.00 #DIV/01 1s Reserve Funds Used for Operating 0.00 #DIV/01 is In-Kind Donations (Naimlu4 inb ll 4380.88 #DIV/01 20 TOTAL 0.00 0.00j852.60 88 #DIVIOI EXPENDITURES 21 Salaries 0070! zz FICA 24 /0! 23 Retirement 04 #DIVIOI 24 Life/Nealth 070125 Workers Com enation 6 /0I26 Florida Unem to ment 4l0!n Travel-Dail 00125 TraveUConferences/Trainin 0 /0129 Office Su lies 00!30 Tele hone 00!31 Posta a/Shi in 4O! 32 Utilities 0.00 #DIVl01 33 Occupancy (Building & Grounds 3,235.00 #DIVIOI 34 Printing & Publications 107.64 #DIVIOI 35 Subscription/Dues/Memberships 0.001 #DIVIOI 36 Insurance 0.00 #DIV/O! 37 E ui ment:Rental & Maintenance 0.00 #DIVIOI 3s Advertising 0.00 #DIVI01 39 Equipment Purchases:Ca ital Expense 0.00 #DIV/01 40 Professional Fees (Legal, Consulting) 0.00 #DIV/01 41 Books/Educational Materials 0.00 #DIVIOI 42 Food & Nutrition 0.00 #DIVIOI 43 Administrative Costs 495.00 #DIV/01 4a Audit Expense 0.00 #DIVI01 45 Specific Assistance to Individuals 0.00 #DIVI01 46 OthedMiscellaneous 1,050.00 #DIV/O! 47 OthedContract 600000 #DIV/01 48 TOTAL 0.00 0.00 2529076 #DIVIOI 4s REVENUES OVER/ UNDER EXPENDITURES 0.00 0.00 4,380.88 #DIVI01 Unite for Families Foster Parent Mentor Program UNIFORM GRANT APPLICATION FUNDER SPECIFIC BUDGET PROGRAM EXPENSES AGENCY/PROGRAM NAME: United for Families/Foster Parent Mentor Program FUNDER: CSAC A B C FY 06107 FY 06/07 % OF TOTAL FUNDER TOTAL VS. PROGRAM SPECIFIC FUNDER REQUEST BUDGET BUDGET (col. 13/col. A) EXPENDITURES 21 Salaries 85526.00 8,400.00 98 .52% 22 FICA 652.24 642.60 98.52% 23 Retirement 341 .04 336 .00 98.52% 24 Life/Health 852.60 840 .00 98.52% 26 Workers Compensation 511 .56 504.00 98 .52% 26 Florida Unemployment 341 .04 336.00 98.52% 27 Travel-Daily 1 ,827.00 19827.00 100.00% 28 Travel/Conferences/Training 210.00 0.00 0.00% 29 Office Supplies 0 .00 0.00 #DIV/01 30 Telephone 1 ,034.00 264.00 25 .53% 31 Postage/Shipping 107.64 107. 64 100.00% 32 Utilities 0.00 0 .00 #DIV10 ! 33 Occupancy (Building & Grounds 3 ,235.00 0 .00 0.00% 34 Printing & Publications 107.64 107.64 100 .00% 35 Subscription/Dues/Memberships 0 .00 0.00 #DIV/O ! 36 Insurance 0 .00 0. 00 #DIV/01 37 Equipment: Rental & Maintenance 0.00 0.00 #DIV101 38 Advertising 0.00 0 .00 #DIV/O! 39 Equipment Purchases : Ca ital Expense 0.00 0.00 #DMO ! 40 Professional Fees (Legal, Consulting) 0.00 0.00 #DIV/0 ! 41 Books/Educational Materials 0.00 0.00 #DIV101 42 Food & Nutrition 0 .00 0.00 #DIV101 43 Administrative Costs 495.00 495.00 100 .00% 44 Audit Expense 0.00 0 .00 #DIVl01 45 Specific Assistance to Individuals 0.00 0.00 #DIV/O ! 46 Other/Miscellaneous 1 ,050.00 1 11050.00 100.00% 47 Other/Contract 61000 .00 6,000.001 100.00% 48 TOTAL $25 ,290.76 $203909.88 82.68% 5!9!2006 BA uni mr Fan Fosb PamntM rPmgram UNIFORM GRANT APPLICATION EXPLANATION FOR VARIANCES OF 75% OR MORE TOTAL PROGRAM BUDGET AGENCY/PROGRAM NAME: United for Families FUNDER: CSAC MODIV101 'g 'w �- �X ' " '�:'= Wi t ! , .. DCPLANA71ONWR VARIANCEr. ' �.. , . #DN/01 #DN101 #DNl01 #DN/01 #DIV101 9DIV101 90N101 #Drv/01 #DMO! #DNI01 1111501 1!1 1 1 I #DN101 MIMI #DN/01 #DN101 #DIV101 #DN/01 #DIVI01 #DIV/01 #ON/01 #DIV/01 #DN/01 #DNI01 4DN101 #oN101 #DN/01 s Gw es Unme mrFamses Foster Parent Mentor Program UNIFORM GRANT APPLICATION EXPLANATION FOR VARIANCES OF 15% OR MORE FUNDER SPECIFIC BUDGET AGENCYIPROGRAM NAME: United for Families FUNDER: CSAC :EXXP,LAWZONJ50XVARIANCE' �ffing '' �= 9. -m-,µ=N* '-'"v. Salaries C C costs are 21 pemem of total cost of establishing the program in four rsunfies. UFF is ranbibuting in-ktrttl to hold down expenses. FICA same Retirement same Life/Health same Workers Compensation same Florida Unemployment same Travel-Dalt same #DN/01 Tele hone same Posta e/Shi In same #DIVn l Printing & Publications same #DN/01 #DN/01 #DIV/UI #DN/01 #DN/01 #DN/01 #DN/01 Administrative Costs same #DN/0! #DN/o! Other/Miscellaneous same OtherlContract same Snow ab Page 1 of 2 Marion Masterson To: Christina Kaiser Subject: RE: childcare tuition assistance Hello Christina The selections of the grant committee were approved last night by the chidren's services advisory committee; so I will be sending out letters soon . These decisions are pending the approval of the IRC Board of Commissioners at budget time. (Funds have been cut before); So far you have been approved for Mentoring Program $20 ,000 Camp Foster child - $ 17,600 Funds will be for Oct 2006 to Sept 30 2007 AFTER Budget time - we will have an orientation re applying for funds, etc. more later - Congratulations ! Marion -----Original Message----- From : Christina Kaiser [mailto :christina .kaiser@UFF. US] Sent: Monday, June 19, 2006 3 : 30 PM To: Marion Masterson Subject: RE: childcare tuition assistance Marion , Can you tell me when we might expect a decision on our grant requests? Christina Kaiser Development Director United For Families 528-0362 -----Original Message----- From: Marion Masterson [mailto : MMasterson@ircgov.com] Sent: Thursday, June 15, 2006 2 : 25 PM To: Barbara Patten (E-mail); Big Brothers & Big Sisters - Judy Miller; Big Brothers & Big Sisters - Mclodee Daniello; Big Brothers & Big Sisters Allan J . Klosche; Boys & Girls Club - Parris; Boys & Girls Clubs - Heidi Watkins; Boys & Girls Clubs - Tracey Kendrick; Catholic Charities - Samaritan Center - Assistant; Catholic Charities - Samaritan Center - Julia Keenan; CEBH - Greg Morgan; CEBH - Mariamma Pyngolil; CEBH - Michelle Bollinger; Childcare Resources - Betsy Camper; Childcare Resources - P King ; Dasie Hope Center Verna Wright; Exchange Club Castle - Carol Ashcroft; Exchange Club Castle Safe Families - Ruth Orenstein; Exchange Club Castle - Valued Visits - Chuttman; Exchange Club Castle (E-mail); GYAC - Anette Reason; GYAC - Mike Hubler; Healthy Start - Leslie Spurlock; Healthy Start - TLC; Hibiscus - Huffert; Hibiscus - Amanda Birdsall - Crisis N Director; Hibiscus - Brooks; Hibiscus - Greg Mead; Homeless Family Center - Leeanne Honey; Homeless Family Center - Roberto Ortiz; HOPE - Henry Burson - academy; HOPE - Henry Burson (Home); SAC - Beverly Norris; SAC - Colette Heid, Cathy Bricker; St Peters Academy - Marge - Cc: Christina Kaiser; Children's Home Society (E-mail); CEBH (E-mail 2); Carolyn Kravitz (E-mail) Subject: FW : childcare tuition assistance Hello Agencies and Interested Parties: I am forwarding this information concening subsidized childcare for those who quality. Apparently there are a few slots open . Please pass this message on to anyone who would benefit from the service. 6/20/2006 Page 2 of 2 Marion Masterson -----Original Message----- From: Rachael Moshman [mailto: rmoshman@childcareresourcesir.org] Sent: Tuesday, August 15, 2006 12 :09 PM To: Marion Masterson Subject: childcare tuition assistance Feel free to print the attached flier for your employees and clients. DO YOU NEED HELP PAYING FOR CHILDCARE ? Childcare Resources of Indian River, Inc. is a private nonprofit organization offering childcare tuition assistance to qualifying families in Indian River County. Each parent living in the household must: • Work full time, attend school full time, or a combination of the two equaling full time • Live in Indian River County • Meet the income eligibility requirements Children are placed at one of 8 high quality, nationally accredited childcare centers in Indian River County. We place children aged infant through pre-kindergarten. Our goal is to help those who fall just over the income eligibility limits for federal and state childcare assistance programs. If your income is within the figures on the chart below, we may be able to offer you some help with childcare expenses. Total Number of People in Household Hourly Pay (all Household Yearly Pay (all Household sources of income sources of income combined) combined 2 $9.25 - $ 12 .34 $ 19,246 - $25 660 3 $ 11 .60 - $ 15 .47 $24, 135 - $32, 180 4 $ 13 .95 - $ 18 . 60 $29,025 - $385700 5 $ 16.30 - $21 . 74 $339915 - $45,220 6 $ 18 .65 - $24 . 87 $38 ,805 - $ 51 ,740 Please call 567-3202 for more information or stop by our office at 1801 24u' Street in downtown Vero Beach. We are currently accepting applications for the 2006/2007 year. FLichnet Me> Naw.. Faw Ly zesou ce conrdinntor Child CgF9 R^Sour_e5 of � 'n.Gi LP, v�- RWer 12G_ 24gl 6t1 0 C. VerC F.eneti, FL. 3296 F:^ cwC ( 2� F - .2^✓2. FAX: ( 2) .i -YZ3 '= 6/20/2006 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 30`") 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 : United for Families 10570 S . Federal Highway, Suite 301 Port St. Lucie, Florida 34996 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 - nq : r � ! I ; t U 1 0 f• ova clan l., 'F, MJ Iti TY IIuURli l, t JG ° '� IbC � Ja � I -r c ' / 0—Row CERTIFICATE OF LIABILITY INSURANCE rWCER DPID . DATE CMw OIYYYYI U1,T- E09 10 25 06 THIS CERTIFICATE 1813SL. ED ASA MATTER OFINFORMATION ■ ova i Brown of Florida , Inc , ONLY AND CONFERS NO Rt3HT3UPON7HECERTIFICATE Daytona Beach Office MOLDER. THISCERTIFICA7c DOES NOTAM6N0, EXTEND OR P . O . Box 2412 ALTER THE COVEIhAGE AMMR06D BY THE POLICIES BELOW. Daytona Bpach 7L 32115-2412 Phons : 386- 252 -9601 Fax : 386-239-5729 --1-ItNSUREAFFORDINGCOVERAGE MAICd —RS-- -- N N"� NSURERA XL specialty Ins_ Co 37D85 PiSIIRCR G: General J _tar Indemnity 37362 United 6amilias , c New Hampehire Ina Co I 23841 10570 SFIDFRAL AST 301 FORT ST =1019 FL 34952 --_. I N4VMER E• ..._ . .� �_._._. .'OVERNGc3_ _ THE POLIGES Or KSURAY,^E 'JSTW MLOW MAK Mk 168'JED TO TME INSURES+ NAMED ABOVE FOR THE POLICY PERIOD W ON:A i c :l nOTWfTHSTAHO WC. ANY REOU94AGNI, TERM DRCDNDITION OF ANY COMPACT OR OTHER OOCl)MENT WTN RESPECT TO WHICH TN19 CERTIFICATE !JA. St ISSUED OR W.YPERIAN, THE INSMANC: AFMOM* PY THE POLICIES DESCRIPEDNEREN SMECTTD ALL THETERMS. EXCLUJ c ANC %(JNi 710NJOrWw 5'POMM.AGGREGATE 4"—A1$ SHOWN MAY HAVt NEEM REDUCED ev RAl7 c: ms. LI0 m SRYI O iYYF OF iN3uRANGE ._,—_..PO:IDYN9ER UN � 6A.�BTFr 1 _ LIYrtJ CdNERALf1ANLRT ---TS EACF OCC RAE GE 51 , 000 OOC X COMKEMOIA, GENERALLIABIJ� OILX89986200 03/15/06 03/15 / 07 _ IOr.� .g 4100 000 CWMS MADEOCl DRI NED EAl A• a.w Y M!+m1 15 , 000 PUMONAL1ACV "NJURY is , , 4Goo , 000 6ENEAA6 NF ATE ' S 3 000 000 OEN'I AGGRE ;/vTE LAET4PRIES PERIiRODV b • CLY.1PrOr AICD 51 , 000 000 IAUTtWOPRC UAWLI}Y 1 --7- •—�— � � -.— I =owl) LIN ' I ANY AUTO I ' E°a =NCNenq F ri ALL OWNED AUTOS I _ aclWAEC' ALTDF ( �PPo�' C'BrelunJ f I MMiED AUTCS � ao01.Y ,N,uR�� ' h + NOIAtrYVNEO AUT05 I (PW 900i7fRIl) F . PROPERTY D.KIAGE GAPl.CE 41MilNY � AM ONLY- FA AMMENT ? F ANY AUTO eA ACC : S OTTER THAN AUtO ONLY: AGG i - 4FXCESNURSRELu L1AMIm — Gi — — 1! ADUA :uIMSM.ne C1OC273878— 5/ CFaCH OOCWREN_CE �03 /1 I ( 5 I • • rE W TIPIE d REIMION YARNMS COVMUTION AND - TM 57ATI> 01R�111 —=�-- IMKOYERA' tJ01F.ITY 1. ANY VROPIaUoWARrNEP)WCU7M 1 F.L EAOM AGGDCA I OFFn;ERMELMER EXCLUOED? — . M s. i1nE'IOC E.L. O'SEASE - EA EMfwrFLi _ _J C.IAL PROVISr!9 SROM I _ E.L. D.9FASF - a]uCr UMrt j f OTHER Wind iICSC966102677601 03/21/ 06 03 /21 /071 f Property Sectio» II4A916961A 03/15 /06 03/ 15/ 07 Contents 150 , pi10 C' MMk OF OPMAM0RS ! LOCATwN$ IVENR'L.ES iEKVLUSIONS ADDED MY EAmORPFNENT I SPECIAL MONSONS :IRTY DAYS NOTICE OF CANCELLATION , TEN DAYS NOTICE DUE To 1q0N- PAYPRN4 X : 772 - 3982925 I ITIFICATE HOLDER CANCELLATION T INDI$OQ iNWLDANYOPIHEA6OVEDESFgIgFDPOLICIEJEECAN'EUFDBENRETHFFJfPIR .nOr GATE TNBt00F THE IEJYIN6INSURER WY,L ENDEAVOR TO MAIL 3O_ DAY6 MMI I �N I NOTICE 70 TRE CERrF'CATE HOLDER NAWO TOM LHIT, PUT FAAIRE TO 01. SO „�LL IMMAN RIVER COUNTY IWNME CRLpAtIONORLWIL'TY09ANI' KMLWONTMEINSUMR, 115ACI 1840 25TH 8T tw6EaNTAm Ex JY3iO SsACH 52 32960 DAEPRE8EN1 IR Zs (20aT !aaM ' eea ve11 Fria. 6I , . . 1 ' 24PI-i V ACORD CORPORATION 186E VO, J1J V46JV V1 V1lLS 14 / VV / a. V Vu [, va � E'aua. aaa aaapaa ra ra • ) : [ Mian River COMPANY : ACORD DATE (N=DrYY) 1201 PRODUCER Serial # 621931 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Ai RISK SERVICES OF FLORIDA HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 1001 BRICKELL BAY DRIVE, SUITE 1100 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. MIAMI, FL 33131 _ COMPANIES AFFORDING COVERAGE (305) 372-9950 COMFAH• A ZURICH AMERICAN INSURANCE COMPANY INSURED __..— _ _—_— -- COUPAN• _—. --___—_.---- B Oasis Outsourcing Holdings, Inc. — Alt. Eni Unite". For Pami !ies, Inc. CCWFAN' 4400 N Congress Ave „ Suite 25C C West Palm Beach, F ! 33407.3268 CCE'FA"'' D THIS IS TO CEP.TIFYT HAT 7H POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POUCIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS EXCLUSIONS AND CONDITIONS O: SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLA'.Ms. CO POUCYEFFECTIVE POLICVEXFIRATIONI LIMITS TYPE OF INSURANCE POLICY NUMBER DATE (MMNDI : DATE ;MWDD/ ) GENERAL LIABILITY GENERA AGGREGA'E ' $ ' CM1%- ERCIA GENERA. LIASLITY PPODJCTG CCMP^OP AGG $ � IUAN5MADE '� UCCJR 'EF'ONAL } ADV !\JIIP+ r _ O'ANER'S & CONTRACTOR'S DFI EACH CCCLF I<CE T$- -� FIRE DA"oAGE (MYore Gre ,, EDE>? (Arty ore Pesx; , 3 AUTOMOBILE LIABILITY I - � ANYAUTO II —COM 3INED SMGLE -MP ' R ALL OWNED AUTOS BD' OhY InJLR'! F SCHEDULED AUTOS •Pei FeTol, HIRED AUTOS I``IBODIL" NON-OWNEC AUTOS Pe Idem• ERTY DAMAGE — c i GARAGE LIABILITY LIr4�ToohL � . E ASCIDEn' is MANY AUTO ' O'HERTHAN AJ—O O.�L r. _ — EACTACCIDEN 3 AGGREGATE is EXCESS LIABILITY EACHOCCUR3ENCE $ UMBRELLA FORM InGGRESATE $ —~' OTHER THAI: L'MBRRLA FCRIa $ A V,ORKER'S COMPENSATION AND 'WC 29.98.687-04 06/01106 06/01 /07 ' x.lrpx%Mils. y_ E _ EMPLOYERSLIABILITY e EACH ACCICcJ' T$ 1000060 IINCL IE.oISEASE1000000 YnN1HEY 5lERECJIIY'_ — UfPC°ITS RITE EXC. NEL EN PL OYEE 5 1090000 OTHER i DESCRIPTION OF OPERATIONSRDCA71ON&VEHICLESISPECIAL ITEMS ONLY THOSE EMF'_OYEES LEASED TO BJT NOT SUBCONTRACTORS OF: UNITED FOR FAMILIES, INC #2011 SHOULD ANY OF THE ABOVE DESCRIBED FOUCIES BE CANCELLED BEFORE THE INDIAN RIVER COUNTY HUMAN SERVICES EXPIRATION DATE THEREOF, THE ISSUING CCMPANY VALL ENDEAVOR TO MAIL CHILDREN'S SERVICES ADVISORY COMMITTEE 30 DAYS MITTEN NOTICETO THE CERTIFICAT'EHOLDERNAMEDTO THE LEFT, ATTN MARION E MASTERSON BUT FAILUPETONAIL SUCH NOTICE SHALL IMPOSE NDOBJGATION CRIJABLITY 1640 25TH ST OF ANY KIND UPON THE CCMPANY, ITS AGENTS OR REPRESENTATIVES. VERC BEACH, =L 32560 ATNE • 10570 S . FEDERAL HIGHWAY, SUITE 301 United PORT SAINT LUCIE, FL 34952 Phone: (772) 398-2920; Fax: (772) 398-2925 for Families w -uff-us OCT . 31 , 2006 Children's Services Advisory Committee of Indian River County Attn: Marion Masterson Dear Marion, Please accept this letter as notification that United for Families will not transport children for its Foster Parent Mentor of suruner camp programs. Thank you, Christina Kaiser Development Director •_ may • ai ' _ . . . . . Surplus Linea Agwt's Name: r M Fo la r aom a !`dminn Redl t'A11 qq S Lino Agent's Address: Py � us r � ,...., a .e..., FL ¢4413 C.a t . -va .. Surplus Imes Agem's Licence• t e er o . iy w .. . ._ Producing Agent's Name: k o -i.,=r--;c. producing Agent's Address: JeJIPr + . 690 2p POLICY NUMBER: SS000011 TotalFreminm: I ;- 0 CG DS 01 10 01 Service Fee: Agents toiai®rarw=/ COMMERCIAL GENERAL & PROFESSIONAL LIABILITY DECLARATIONS ASPEN SPECIALTY INSURANCE COMPANY CRC Insurance Services , Inc. 99 HIGH STREET 30 Jericho Executive Plaza, Suite 200C BOSTON , MASSACHUSETTS 02110-2320 Jericho, NY 11753 NAMED INSURED : United for Families, Inc. MAILING ADDRESS : 10570 S. Federal Hwy., Suite. 201 Port St. Lucie, FL 34952 POLICY PERIOD: FROM 03/1512005 TO 03/15/2006 AT 12 : 01 A.M. TIME AT YOUR MAILING ADDRESS SHOWN ABOVE 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. LIMITS OF INSURANCE GENERAL LIABILITY i EACH OCCURRENCE LIMIT $ 190000000 DAMAGE TO PREMISES RENTED TO YOU LIMIT $ 100,000 Any one premises MEDICAL EXPENSE LIMIT $ 55000 Any one person PERSONAL & ADVERTISING INJURY LIMIT $ 11000,000 Any one person or organization GENERAL AGGREGATE LIMIT $ 3, 0001000 PRODUCTS/COMPLETED OPERATIONS AGGREGATE LIMIT $ 190009000 Surplus Lines Tax: — .1t 690 • Lo PROFESSIONAL LIABILITY FSLSO Tax: Each Medical Incident Policy Fee: $ 1 ,000, 000 Aggregate Insp. Fee: Company Fee: $ 3,0001000 Retroactive date (If Applicable) FL EMPATF: N/A Deductible NONE Each Medical Incident or Claim (Including ALAE A-oy38o � i � 95 $2 . DESCRIPTION OF BUSINESS FORM OF BUSINESS : ❑ INDIVIDUAL ❑ PARTNERSHIP () JOINT VENTURE ❑ TRUST ❑ LIMITED LIABILITY COMPANY X ORGANIZATION, INCLUDING A CORPORATION (BUT NOT i INCLUDING A PARTNERSHIP, JOINT VENTURE OR LIMITED LIABILITY COMPANY) CG DS 01 10 01 © ISO Properties , Inc. , 2000 Page 1 of 2 ❑ BUSINESS DESCRIPTION : Social Service Agency ALL PREMISES YOU OWN , RENT OR OCCUPY LOCATION NUMBER 001 1 AS PER SCHEDULE ON FILE WITH COMPANY CLASSIFICATION AND PREMIUM LINE OF CLASSIFICATION PREMIUM TRIA TOTAL INCEPTION COVERAGE PREMIUM PROFESSIONAL LIABILITY As per $ 10,326 $310 $ 10, 636 Supplemental COMMERCIAL GENERAL As per $35075 $93 $39168 LIABILITY Submission on file TOTAL INCEPTION PREMIUM $ 13,804 MINIMUM RETAINED PREMIUM $3,451 AUDIT PERIOD (IF APPLICABLE) ❑ ANNUALLY ❑ SEMI- ❑ QUARTERLY ❑ MONTHLY ANNUALLY ENDORSEMENTS ENDORSEMENTS ATTACHED TO THIS POLICY: SEE SCHEDULE OF APPLICABLE FORMS THESE DECLARATIONS, TOGETHER WITH THE COMMON POLICY CONDITIONS AND COVERAGE FORM(S) AND ANY ENDORSEMENT(S), COMPLETE THE BO LIMBERED POLICY. Countersigned: By: 3118105 ( thon Representative) Page 2 of 2 © ISO Properties, Inc. , 2000 CG DS 01 10 01 11