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HomeMy WebLinkAbout2006-331B. 4-4 J aaa6 _33 INDIAN RIVER COUNTY GRANT CONTRACT This Grant Contract ("Contract") entered into effective this day of October 2006, by and between Indian River County, a political subdivision of the State of Florida; 1840 25'h Street, Vero Beach , Florida, 32960-3365; and St. Peters Human Services , Inc. , (Recipient), of: St. Peters Human Services , Inc. , 425038 1h Avenue Vero Beach , Florida 32967 Boy's Development and Training Institute 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 : THIRTY SIX THOUSAND, DOLLARS ($36,000). 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 . f INDIAN RIVER COQJNJ BOARD ,OFrCOMMISSIONERS By ArthurR. `N'eu BCC Approved : � �U Attest: J . K. Barton, Clerk /} By: bJ Deputy Clerk 1 Approved : Josep A. Baird County Administrator Approved as to form and legal sufficiency: Byi� - - � // CvTanan E. Fell , Assista t County Attorney RIE IP NT: By: eters Human Se i es, Inc. - 4 - EXHIBIT A (Copy of complete Request for Proposal) EXHIBIT - A - EXHIBIT B (From policy adopted by Indian River County Board of county Commissioners on February 19, 2002) "D. Nonprofit Agency Responsibilities After Award Funding Indian River County provides funding to all nonprofit agencies on a reimbursement basis only. All reimbursable expenses must be documented by an invoice and/or a copy of the canceled check. Any expense not documented properly to the satisfaction of the Office of Management & Budget and/or the County Administrator may not be reimbursed . If an agency repeatedly fails to provide adequate documentation , this may be reported to the Board of Commissioners . In the event an agency provides inadequate documentation on a consistent basis , funding may be discontinued immediately. Additionally, this may adversely affect future funding requests . Expenditures may only be reimbursed from the fiscal year for which funding was awarded . For example, no expenditures prior to October 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`h) 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 - MEMNON 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 1h Street Vero Beach , Florida 32960-3365 Recipient: St. Peters Human Services, Inc. , 4250 381h Avenue Vero Beach , Florida 32967 2 . Venue : Choice of Law. The validity, interpretation , construction , and effect of this Contract shall be in accordance with and governed by the laws of the State of Florida only. The location for settlement of any and all claims, controversies , or disputes, arising out of or relating to any part of this Contract, or any breach hereof, as well as any litigation between the parties, shall be Indian River county, Florida for claims brought in state court, and the Southern District of Florida for those claims justifiable in federal court. 3 . Entirety of Agreement. This Contract incorporates and includes all prior and contemporaneous negotiations, correspondence, conversations, agreements , and understandings applicable to the matters contained herein and the parties agree that there are no commitments, agreements, or understandings concerning the subject matter of this Contract that are not contained herein . Accordingly, it is agreed that no deviation from the terms hereof shall be predicated upon any prior representations or agreements , whether oral or written . It is further agreed that no modification , amendment or alteration in the terms and conditions contained herein shall be effective unless contained in a written document signed by both parties. 4. Severability. In the event any provision of this Contract is determined to be unenforceable or invalid , such unenforceability or invalidity shall not affect the remaining provisions of this Contract, and every other provision and term of this Contract shall be deemed valid and enforceable to the extent permitted by law. To that extent, this Contract is deemed severable . 5 . Captions and Interpretations Captions in this Contract are included for convenience only and are not to be considered in any construction or interpretation of this Contract or any of its provisions . Unless context indicates otherwise, words importing the singular number include the plural number, and vise versa. Words of any gender include the correlative words of the other genders , unless the sense indicates otherwise. 6. Independent Contractor. The Recipient is and shall be an independent contractor for all purposes under this Contract. The Recipient is not an agent or employee of the County, and any and all persons engaged in any of the services or activities funded in whole or in part performed pursuant to this Contract shall at all times and in all places be subject to the Recipient's sole direction , supervision and control . 7 . Assignment. This Contract may not be assigned by the Recipient without the prior written consent of the County. EXHIBIT - C - OCT- 12-20bb 14 : 32 HH1UHtK 1HbUKHNLt IINU . 4101 o41 t000 r . uc AcoRp CERTIFICATE OF LIABILITY INSURANCE pppp """ '"`""" S PETE.1B 10 / 12 /06 PRODUCER THIe CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Hatcher Insurance , Inc . HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR p . 0 . Box 540689 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Orlando FL 32854 - 0689 Phone : 407 - 841 -2686 Fax : 407 -941 -2688 INSURERS AFFORDING COVERAGE - NAIC0 INSURED INSURER A: FNuadP! la Inaaeance egg _ R•16URER 0: cnaPareP &Rd Ia0m,t" CPeP5PY at . Peters Academy Charter SCh INSUpFR C. - 4250P4tt.ers umen Services , Inc -• - - Vero eaacch rLn3;967 - 1711 INSURER INSURER 8; COVERAGES THE pOLN:N!S OF INSURANCE LISTED BELOW HAVE SEEN ISSUED TO THE INSURED NAMEO ABOVE FOR THE POLICY PGRIOD INDICATED. NOTWITMSTANONI G ANY REOUFLEMENT, TERM OR CONDITION CF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE WSVRANCE AF FORDED BY THE POLICIES OE$CRIOEO HEREIN 15 SUBJECT TO ALL THE TERMS. E (CLUSIONS AND CONDITIONS OF SUCH POLIC KA. AGGREGATE LIMITS SHOWN NAY HAVE BEEN REDUCED By PAN) CLAVAS LTR NSR MINBIMUINGE POLICY NUMBER DAT Mm'0 LIMITS OBNERAL LIABMTY EACH OCCURRENCE 11000000 UXONSE A X X COMIAERCIALGENERALLIABLITY PHPX190953 09/17 /06 09/17 / 07 PREMISE$ Eaa mwr� F 100000 CLAIMS MADE � OCCLIN MED EJ? WryalM Psngn) $ 5000 X Educators Prof PHRK190953 09/17 /06 09/ 17 /07 PERGONALSAOVINJURY 51000000 GENERAL AGGREGATE s2000000 GEN'L AGGREGATE LOT APPILIEB PER: PRODUCTS . COMPIOPAGO 62000000 POLICY PRT LOC AUTOMOBILE LAOILITY COMBINED SINGLE IIOT y ANY AUTO (Fs sodwo ALL OWNED AUTOS BODILY INJURY ly GCMEDULEO AUTOS MPR( IMNR(H) .. .. HIRED AUTOS BODILY INJURY y NON-0WNIID AUTOS IM1r aTod.nU - PROPERTYCAMAGE y _•• •� (PR( SFcppnH) GARAM LIABILITY AUTO ONLY - EA ACCIDENT— 6 _ ANY AUTO OTHER THAN EA ACC 5 _ AUTO ONLY. AGS• I ERCESBNMIWLLA LIABILITY EACH OCCURRENCE $ 1000000 A X OCCUR � cu1MSMAoe PHOS070600 09/17 /06 09/ 17 /07 AGGREGATE 51000000 s DEDUCTIBLE T f X RETENTION $ 10000 _ y WORKERS COMPENSATION AND X T RY LIMI ER MPLoreIVw LRm 1fC8967849 09/ 17 / 06 09/ 17 / 07 B.L. EACH ACCIDENT $ 100000 B FA OFFICFRPRA R1 EKCLUDEEDDiECVf1Vf E.L. Ole!ASB - GA EMPLOYE 1 10000 0 spedia PPRWAwNS DMPP L E.L. DISEASE - POLICY LIMIT $ 500000 OTHIA OCscRI►TION M DPE WTgNB/ LOCATIONS I VENICIlS I =CLUB*" PROW BY FM�T I SPECIAL PROVISIONS Certificate holder is included as additional insured regarding general liability . Liability is limited to los■ or damage arising out or negligent acts of the insured . *Except as required by Florida Statute . CERTIFICATE HOLDER CANCELLATION INDIAN BNDULDANYOFTNB A80 M$CNBED INxJHRJS Y DANCELLBD BEFORE THE EMKA DATETHEITEOP, TMIUUMONSURERMLLENDBAVORTOMAUL 30 • DAYSWRITTEN NOTICE TO TILE CARTMICATS HOLDER WIRED TO THE LEPT. BUT FAILURE TO 00 SO SHALL Indian River County , Florida IMPOSE No OBUGATICN OR LIABILITY OF ANY KIND UPON ME INSURER. m AUNTS ON 1840 25th Street Vero Beach FL 32960 -3365 NBMEBENTATIVPJ. AM R ACORD 25 (2001100) MDACORO CORPORATION 1900 TOTAL P . 02 CERTIFICATE OF INSURANCE SUCKJOURAME AS RESPECTS THE INTEREST OF THE CERTIFICATE HOLDER WILL NOT BE CANCELED OR OTHERMSE WITHOUT GIVING 10 DAYS PRIOR WRITTIMN NOTICE TO THE CERTIFICATE HOLDER KAMM SIBLUiRs gVT IN No THIS CERTIFICATE BE VAUD THAN 30 DAYS FROM THE DATE WRITTEN. THIS CERTIFICATE OF INSURANCE 1 C • J PROVIDEDBy ANY POLICYDESCRIBED _ INWAM STATE FARM MUTUAL AUTOMOBILE INSURANCIE COMPANY of 111cominWri, tilinak, or STATE FARM I'M AND CASUALTY COMPANY of 810MM2W. Illinois has omersm- on the following Named Irmired asahown below : Address of Nomad kNRmW 42W 3e Ave. 32957 POLICYNUMDOW -t EFFECTIVE NNW' loompi POLICY �r DESCRIPTION OF 11111114DIODGE1111100VM Im WE an HIM FORD INUMAVISTMM VEMCLE EISO VAN Nis Lmfb Lir m nr " Pawn PKIRRIF own"3"k Limit Each AS ® PKYSICIALnTr - COVERAGES Y.. 1 I $250.00 . , $260.00 Deductible Y 1 W I _ 11 11 Deductible NI 11•I Deductible '. 1,1 11 Deductible :111 Q1 Deductlible EMPLOYIEWS NON-OWNPR" C3YES ONO OYES ONO DYES 11NO Om ONO l 199wAgent zrj3 10/13106 ! YES MWES Name and Ad i a am of Certificate Holder Nam and Address orAgam Indian Rivw County David E. Hedgalk , .. 1StreeM11 2f Vero SmIliv FL 1 Vero Eleach, FL :, Check if a permenant Cerwaste of Insurer= for liability coverage is needed:Check if the Certificate Holder should be added as an Additional Insured: ■ 0 Organisation: St. Peter's Human Services, Inc. Program: St. Peter's Boys Development & Training Institute Founder. Children's Smice Council PROGRAM COVER PAGE Organization Name: St. Peter's Boys Development and Training Institute Executive Director: Pastor Andrew Jefferson E-mail :stpetersschool�bellsouth.net Address: 4250 38"' Avenue Telephone: 772-562-6863 Vero Beach, Fl 32967 Fax: 772-562-8920 Program Director: Mr. Edward Coney E-mail : Same as above Address: Same as above Telephone: Fax: Program Title: Boy' s Developmental and Training Institute Priority Need Area Addressed: To reduce juvenile delinquency and crime Brief Description of the Program: The program seeks to provide for school age children and teens access to a weekend training program that offers recreation academic supportself esteem character building and community services experience The program also Provides positive role models through investors to equip the boys with knowledge about substance abuse violence and gang activity. SUMMARY REPORT — (Enter Information In The Black Cells Onl Amount Requested from Funder for 2006 /07 : $ 61 ,386 . 71 Total Proposed Program Budget for 2006 /07 : $ 61 ,386 . 71 Percent of Total Program Budget : 100 . 0 % Current Program Funding (2005 /06 ) : $ 36 , 106 Dollar increase/( decrease) in request : S 25 , 281 Percent increase /(decrease ) in request * * 70 . 0 % Unduplicated Number of Children to be served Individually : 50 Unduplicated Number of Adults to be served Individually : - Unduplicated Number to be served via Group settings : 50 Total Program Cost per Client : 61 ; 87 "If request increased 5% or more, briefly explain why: The program is requesting an additional 16,094.00 for food and $2,600.00 for transportation as indicated in the variance section of the application. If these funds are being used to match another source, name the source and the $ amount: The Organization 's Board of Directors has approved this application on (dte), Andrew Jefferson17, " Name of President/Chair of the Board Sign Larry Taylor Name of Executive Director/CEO Signature Ll 3 • Organisation: St Peter's Human Services, Inc. Program: St Peter's Boys Development & Training Insllhne Founder. Children's Service Council PROPOSAL NARRATIVE Please respond to each question in the allotted space for each section. In responding to each section of the proposal narrative, please retain the section-label and/or question that you are addressing. Type using 12 pt. font on 8 ''/z" X 11 " paper and number each page. These directions and the graphic boxes may be deleted if space is needed. A. ORGANIZATION CAPABILITY (Entire Section A not to exceed one page) 1. Provide the mission statement and vision of your organization. Mission Statement: St. Peter' s Human Services, Inc. ' s mission is to increase the success rate of high risk students by providing educational support, drug awareness, and character education through operation of a public school of choice. The organization works cooperatively with established social programs to assist the targeted population of Indian River County to become self sufficient members of society. Vision: The St. Peter' s Human Services Corporation is a non religious, non denominational organization in operation since December 1996. The Agency ' s vision is to address social problems and needs in targeted areas of Indian River County, Florida. The agency is designed to provide short and long term services in the areas of affordable quality child/daycare services, before and after school childcare, public school of choice for children with special needs who may not be successful in the regular school system, youth intervention programs, and assisted living care for certain targeted groups. 2. Provide a brief summary of your organization including areas of expertise, accomplishments, and population served. Since is incorporation, the agency has provided quality daycare services for families with children ages zero to five years of age. The center also serves children who are Title 20 and ALPI Certified. The agency has a chartered public school of choice, serving 90 to 100 "at-risk" students of Indian River County. The Agency has also successfully implemented a Girl ' s Development and Training Program for the targeted population, ages 7 to 16. The program' s highlights include organized drills, academic support, self esteem/character building, and exploration and exposure to educational and recreational activities through field trips and workshops. The Program is the only one of its kind in Indian River County. 4 Organ"on: St. Peter's Human services, Inc. Program: St. Peter's Boys Development & Training Institute Founder: Children's Service Council 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. The unacceptable condition is juvenile delinquency that leads to further lives of crime, truancy, dropping out of school, low self esteem, etc . because the approach has been only to lockup the offenders without changing the behaviors. b. The children in need are the at-risk males between the ages of 7 and 16 who are discouraged learners, have low self-esteem, stressful family conditions, and have exhibited problem behaviors, such as school disciplinary referrals, chronic school truancy, repeated school suspensions, poor academic performance, a history of alcohol, tobacco and other drugs, rebellion, running away, mental and emotional health issues and those with a history of delinquent behavior. c. In Indian River County, 90% of the at-risk males involved in the program are from the surrounding community. d. DJJ's Key Juvenile Crime Trends and Conditions states "In Fiscal Year 1999-2000, 104, 176 juveniles were referred for delinquency. They were charged with committing 150,747 crimes. . . There was a 229 percent increase over the last decade in juvenile offenders referred for drug use. . . Florida, the fourth largest state, still tries more juveniles as adults than most states . . . 14 percent of juvenile offenders can be classified as chronic . . . The high mobility of youth and families in Florida, who frequently change home neighborhoods and schools, is a risk factor that increases delinquency . . . young people don't feel like they have consistent positive communities . . .Juvenile offenders in Florida typically come from single parent households and are truants, dropouts or are doing poorly in school . . .three out of four youth in treatment programs admit to alcohol or drug use, 29% are emotionally disturbed, 20% have a diagnosed serious mental illness, 9% are sex offenders and 5% have developmental disabilities." Bill Bankhead, DJJ Secretary stated, "We know from research the high risk factors for delinquency and they include poor school performance, truancy, family instability and running away." 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. There are two programs that serve the targeted population, however neither of the programs are structured to address the additional areas provided through the Boys Development Institute. la. Gifford Youth Activity Center provides an after school day program for all youth, not just males_ lb. The program does not provide many of the services rendered by our program i.e. mentoring, community services, Life Skills, Drug Awareness and Character Education, overnight stay on site, meals, recreational, and academic support and tracking the boys for six months after successful completion of the program through DJJ, schools and parents. 2a. Hope Academy provides an alternative day program for suspended students from public schools, while the Boys Institute seeks to serve the social, emotional and academic needs of the child, ensuring that all areas are addressed. 5 ' Organization: St. Peter's Human Services, Inc. Program: St. Peter's Boys Development & Training Institute Founder. Children's service Council C. PROGRAM DESCRIPTION (Entire Section C. 1 — 6, not to exceed two pages) 1. List Priority Needs area addressed. To reduce juvenile delinquency and crimes. 2. Briefly describe program activities including location of services. Activities. Results. and Program Requirements: The following services will be provided/required by the program: tutoring and academic instruction, counseling (rehabilitative, social, mental and emotional), drills for discipline training, character and self esteem building classes, conflict resolution and life skills classes, rap sessions to develop communication skills, recreational activities, field trips, mentoring, guest speakers, etc. Overall results : reduced juvenile delinquency and increased self esteem and responsibility. Process and Intended Outcomes Client Involvement from start to finish: Referrals are made by schools, local churches, parents of enrolled boys and from other partnering agencies. The boy is accepted into the program and must participate on every level while attending. The boy ' s school attendance, records, etc ., are closely monitored and discussed during the duration of the program. Above is a list of those areas in which the boy will participate. Expected Outcomes and Chanes: The outcomes generally include increased academic performance, decreased negative behavior, improved relationships among peers, increased community awareness and increased awareness of substance abuse addiction and HIV risk factors. The outcomes that would benefit the community include reduced juvenile delinquency, reduced crimes, increased responsibility as a citizen of the community, etc. Follow- gR: After successful discharge, the boys are followed up on a monthly basis through DJJ for a total of six months. In addition, a concerned parent/school official is encouraged to contact the program director if there are any situations that arise that might be handled by the program director or counselors. The services are provided at St. Peter' s Missionary Baptist Church, 4250 38th Avenue, GiffordNero Beach, Fl, 32967. The hours of operation are from Friday, 4:30 p.m. through Saturday, 5 : 00 p.m. 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 Boys Development and Training Program addresses the need to reduce juvenile delinquency by providing a program for at-risk males who are affected by chemical addictions, violence, poor family environment, and lack of social and academic skills, poor self esteem and other areas in need of improvement in a male youth' s life. The focus of this program centers on addressing these young male issues along the same lines as DJJ, as indicated in the editorial written by the Secretary of DJJ, Bill Bankhead, where he stated (concerning the DJJ programs), "Individualized resources that meet the needs of the particular juvenile and his or her family are provided. These can include mental health counseling, substance abuse treatment and tutoring . . . to get everyone working together positively on issues and to give the kids a way up and out of failure. " When looking at the Boy's Institute, these areas have been addressed through a variety of mediums, discipline training, academic accountability, tutoring, parental involvement, community involvement (which increases ties to the community), mental health 6 ' Organibdon: St. Peter's Hummt Services, Inc. Program: St. Peter's Boys Development & Training Institute Founder: Children's service Council assessment and counseling, substance abuse awareness and referral (if necessary), etc. The DJJ report on Community Involvement indicated that evidence show that communities can deter juvenile crime by targeting the key risk factors of truancy, school failure, access to weapons, not enough positive activities to keep kids busy. It indicated that " . . . some of the same strategies that can prevent delinquency from ever happening in a child's life also can stop a juvenile offender from re-offending and recycling back into the delinquency system." The articles closes with this statement: "No matter how good an individual juvenile system program strives to be, a young person sooner or later returns to his home community." St. Peter' s Boys Development and Training Program assists in diverting the boys' lives away from crime in their communities. It is a community program that develops community attachments for the youth while addressing the needs that placed the child at risk in the first place. According to DJJ Secretary, Bill Bankhead, " . . . outreach must be done in the neighborhoods where juvenile crime is high." Governor Bush said of the successful outreaches, ". . . they focus on preserving the unity and integrity of family and emphasizing parental responsibility in dealing with troubled youth." (www.dii .state. fl . us/featuresl'runaways .htm]). Delinquency prevention is paramount to DJJ' s plan, which includes three elements: targeting the most at risk, cooperation between community- based programs working with the government to approach families, and accountability through data collection and measurement of program success. The Boys institute does all three and goes beyond in preventing or reversing the patterns and risk factors associated with delinquency. 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). 1 — Administrator (PT, BA degree preferred, 2 yrs. Experience working with at-risks children). Oversees the overall operation of the program, including data collection, quarterly-reporting and financial management of the program. Supervise and oversee all staff, including book-keeping, clerical, operations; must also meet with parents, teachers and outside agency representatives regarding the program. 1 — Program Operations Manager (PT, Minimum HS diploma/equivalency, training in child development, at least 2 years experience in working with at-risk children). Responsible for overnight supervision of program. Will monitor institute teachers and trainers in addressing the social and educational needs of the enrollees, ensuring a safe, nurturing environment conducive to learning. House parenting for the weekend, discipline, drills, activities and planning of activities. Also work with institute staff, mentors and volunteers. 2 — Institute Teachers (Part time. Must have educational experience in working with at-risk children.) Will teach appropriate information addressing educational needs of enrollees during program hours including computer instruction and reading clinic; will monitor progress and maintain records. 1 — Institute Prevention Coordinator (BA degree in related field and/or 2 years of experience in social setting working with youth. Knowledge of children and teaching basic skills.) Recruitment and new referrals, handle data, planning, parent training, discipline, counseling and assist with data collection from schools including school visits, on-site monitoring and coordination with teachers. 7 • Organization: St. Peter's Human Services, Inc. Program: St. Peter's Boys Development & Training institmc Founder Children's Service Couacil 5. How will the target population be made aware of the program? The program continues to provide awareness through word-of-mouth advertisement, flyers, local churches, parents, and through collaboration with other partnering agencies. 6. How will the program be accessible to target population (i.e., location,transportation, hours of operation)? St. Peter's Boys Development and Training Institute is located in the heart of 90% of the targeted population. The address is St. Peter's Missionary Baptist Church, 4250 38'h Avenue, Vero Beach, FL. Transportation is provided by the parents and Institute staff when needed. The program is open from Friday, 4:30 p.m. to Saturday, 5 :00 p.m. 8 Organiistim: St. Peters Human Services, Ina Progam: St. Peter's Boys Development & Training Institute Founder. Children's Service Council D. MEASURABLE OUTCOMES (Description oflntent) Use the Measurable Outcomes form. 77tis desc • bort paze does not need to be included in the ro sql In order to show the impact that your program is having on the target population and the community, the funders are requiring measurable outcomes. Please review the examples and summaries below to insure your understanding of what is expected. OUTCOMES: Describes what you want to achieve with the target population. Indicates the results of the services you provide, not the services you provide. Outcomes utilize action words such as maintain, increase, decrease, reduce, improve, raise and lower. ACTIVITIES: Describes the tasks that will be accomplished in the program to achieve the results stated in the outcomes. Activities utilize action words such as complete, establish, create, provide, operate, and develop. The activities should reflect the services described in the PROGRAM DESCRIPTION C2). Use the following elements to develop your outcomes. All elements must be included: • Direction of change • Time frame • Area of change • As measured by • Target population • Baseline: The number that you will be • Degree o chane measuring against Example I (Outcome): To decrease (direction of change) number of unexcused absences (area of change) of enrolled boys and girls (target population) by 75% (degree of change) in one year (time frame) as reported by the 2003 School Board attendance records (as measured by). Baseline : 2003 School j Board attendance records for enrolled boys and girls. I Example I (Activity): To provide anger management classes to enrolled boys and girls 2 times a week for 12 weeks. i Example 2 (Outcome): 75% (degree of change) of youth (target population) who have participated in the academic enrichment activities (as measured by) for 6 months or more (fime frame), will improve i (direction of change) their scores in one or more subject area (area of change) . 25% of participants in academic enrichment activities will maintain the initial level of performance assessed at entry. Baseline : Pre-test scores from the academic enrichment test. Example 2 (Activity) : 1 ) Provide pre and post-test exercises on the Advanced Learning System software; 2) Participants will go through the one lesson per week and be graded for 10 weeks. IMPORTANT NOTE: Keep in mind when developing your PROGRAM OUTCOMES, that if funded, this will be what you are held accountable to accomplish. Also, the PROGRAM OUTCOMES should reflect the information described in the PROGRAM NEED STATEMENT (B1 ). All Program Need Statements should flow from the Mission & Vision. Measurable Outcomes should be based on and measure program needs. Activities are the tasks you do that are going to influence the outcome and impact the unacceptable condition in your Program Need Statement. 9 Organbation: St. Peter's Human services, Inc. Program: St. Peter's Boys Development & Training Institute Founder. Children's service Council D. MEASURABLE OUTCOMES (Entire Section D not to exceed two pages) OUTCOMES ACTIVITIES Add all of the elements or the Measurable Outcomes Add the tasks to accomplish the Outcome(s) OBJECTIVE #1 : Improved academic Provide tutoring each week to enrolled boys performance. Seventy-five percent (75%) of including a designated study hour each week. the program participants will increase their Provide classroom Instruction each Saturday GPA (grade point average) by a minimum of morning from 9:00 a.m. — 12:00 p.m. in critical 25% by the end of the school term each year. core subjects. Measuring tools — Brigance Comprehensive Inventory of Basic Skills pre- OBJECTIVE #2: Decreased post test, report cards and progress reports. negative/disruptive behavior. Sixty five percent (651/o) of the participants will reduce the Provide rap sessions for enrolled boys weekly. number of school behavior referrals for Provide mentoring with positive role models disruptive behavior, including bullying and on a weekly basis. Provide character/self aggression toward peers and adults, as esteem training sessions, and conflict measured by school disciplinary records and resolution. Measuring tools: Entrance Behavior weekly parent behavior report forms. Description Report — reviewed beginning, mid and end of year-collect and monitor school OBJECTIVE #3 Raise Awareness level of behavior and discipline forms. chemical addictions, STD and HIV for enrolled boys. Eighty-five percent (85%) of the boys Invite guest speakers from the Substance will show increased knowledge of drug abuse Abuse Council, Indian River County Health addictions and effects, STD, and HIV by the Department, and other agencies. Training end of the program each year as indicated in sessions will be held by Substance Abuse pre and post surveys and questionnaires. Council, IRC Health Department, and other Agencies that will address alcohol, drug abuse, STD, HIV, abstinence, etc. Measuring tools: pre-post tests/questionnaire. The Institute will OBJECTIVE #4 : Increase community hold a minimum of four sessions per year. awareness and develop community attachments for youth through participation in community Program participants will take part in at least service projects. three major community service oriented projects each year, i.e. Habitat for Humanity, Faith Based projects and community clean-up events. 10 • Organization: St. Peter's Human Services, Inc. Program: St. Peter's Boys Development & Training Institute Founder. Children's Service Council 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 agreern t letters. Collaborative Agency Resources provided to the program Substance Abuse Council Drug Awareness Sheriff's Department Scared Straight Jail Tour IRC Health Department Sexually Transmitted Diseases Gifford Youth Activity Center Seminar, "Raising Them Chaste" Black Faith-Based Organization, Inc . Basketball Tournament IRC Mental Health Center Referrals — Individual and Family Services 11 Organiiatioa St Peter's Human Services, Inc. Program: St. Peter's Boys Development & Training I ntidrte Founder. Children's Service Council - 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 111 ? The information to be collected includes: name, age, ethnic background, birth date and grade. To qualify for the target population, a prospective enrollee will be at-risk for at least two of the following conditions: At-risk males between the ages of 7 and 16 who have exhibited at least two of the problem behaviors as follows: school disciplinary referrals, chronic school truancy, repeated school suspensions, poor academic performance, a history of alcohol, tobacco and other drugs, rebellion, running away, mental and emotional health issues and those with a history of delinquent behavior. The unacceptable condition is juvenile delinquency and is documented through DJJ reports, school reports, parent reports, etc. This shall be documented and maintained through a database and spreadsheet programs. 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? Data will be collected from participants via progress reports/report cards on a nine week basis. Copies of schedules and activities listing the study hour, rap sessions and dates and times of guest speakers will be maintained on location. An entrance description of behaviors will be maintained and reviewed quarterly for improvement. Upon exiting a program, a summary of progress made while attending the program will be documented. Measurement items include grades, attendance sheets, progress reports, school conduct codes report, pre and post test reports, counselor reports, prevention activity attendance sheets, etc. The progress report/report cards will be collected every nine weeks and at the end of the semester. The schedule of activities will be collected every nine weeks and at the end of each semester. The schedule of activities will be collected on an ongoing basis. The entrance and exit behavior description will be collected upon entering and exciting the program. Progress notes on behavior improvement will be documented quarterly or as needed. After successful discharge, there will be a monthly follow-up for six months via parents, school and DJJ. 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 data will be compiled in a notebook under each activity and also copies of the progress/report cards will be placed in each enroIlee's file. The information will be provided upon request to any requesting agency, collaborative partner and the Human Service Board of 12 Organiiation: St. Peter's Human Services, Inc. Program: St. Peter's Boys Development & Twining Institute Founder. Children's Service Council Directors. In areas where the increase in a positive attribute is low or minimal, the program director and board will determine and research new ways to implement a more substantial increase in the positive attribute. It will also be utilized to determine what is working so that it can be continued. 13 Organisation: St. Peter's Human services, Inc. Program: St. Peter's Boys Development & Training Institute Founder. Children's Service Council G. TIMETABLE (Section G not to exceed one page) 1. List the major action steps, activities, or cycles of events that will occur within the program year. New programs should include any start-up planning that may occur outside the funding year. In completing the timetable, review information detailed in prior sections. Month/Period Activities Weekly Tutoring — study hour and classes 9:00 a.m. — 12 : 00 p.m. Saturdays. Weekly Character/self esteem building sessions; community activities; conflict resolution. As needed - ongoing Life Skills sessions; rap sessions Each nine weeks Academic improvement (progress reports and report cards) Weekly — ongoing Reducing negative behaviors — through rap sessions, field trips, seminars, training and mentoring. Weekly Recreational activities and drills Weekly Institute counseling and referrals. 14 Number1 UndupficatedCifients 1 Location 1 ✓. 1 I -: >' �`Yii � Il p8`I `In 't YI I I' � ` I „ _ �. 11 1 W. : 1 I A11 1 Y: : 1 M- 1 6 1 . ' i I I 1 1 RM 1 .11 . 1 \ 8 �/_ JI \ -S■�, . MITTIMMIM M, 1 ,- 1 J 11 1 111 1 II 1 1 1 ✓ i l l i Number1 Unduplicated "entsby Age "57- � • 4�i � �� 1�1 � i 1 � I I 11 1 l c III / Flit this Header. ]�B£ the organization IRA program name Wd the funder for whom it is being completed. The page N a afteady set at the bottom right of every page. I. BUDGET FORMS - To open the Budget Forms, please double-click on the icon below. IWHffl 'Core Budget Forme 16 Type the OrgmiZaim aM PFWM Name UNIFORM GRANT APPLICATION BUDGET NARRATIVE WORKSHEET IMPORTANT: The Budget Narrative should provide details to justify the amount requested in each line item of the budget for your program. From this worksheet, your figures will be linked to the Total Agency Budget, Total Program Budget and Funder Specific Budget Fortes. AGENCY/PROGRAM NAME : Boys Development & Training Institute FUNDER: Children 's Services Council - . . . . . . . . . . . . . . . . . . . . . . . . . . _ . . _ . . _ . . _ . . _ . . _ . . . . . . . . _ - . . . . . . . . . . - . . . . . . . . . . . . . . . . . . . . . . . i . CAUTION : Do not enter any figures where a cell is colored in dark blue - Formulas and/or links are in place. Gray areas should I be used for calculations and to write information only. I e REVENUES W Proposed Total Program Funder,Speetffc Total Agency „`I Bud9at ; � .Budget Budget 1 Children's Services Council-St. Lucie 2 Children's Services Council-Martin 3 Advisory Committee-Indian River 61 ,386.71 61 ,386.71 61 ,386.71 4 United Wa St Lucie County 5 United Way-Martin County 6 United Way-in ian River County 7 Department of Children b Families 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 8 Bequests 17 Funds from Other Sources 16 Reserve Funds Used for Operating 19 In-Kind Donations (Not included in total) 20 TOTAL REVENUES (doesnt include line 19) $61 ,386.71 $61 ,386.71 $61 ,386.71 A B r C D EXPENDITURES r Proposed Total Program ride Speck , Total Agency BtldJaf Budget "T� 21 Salaries - (must complete Chart on next page 36,872.00 36,872.001 36,872.00 Salary I _ 22 FICA - Total salaries x 0.0765 7.66% 2,820.71 2.820.71 2,820.71 Retirement - Annual pension for qua le - 23 staff 0.00 e ea - e ica n -tens 24 Disab. - 0.00 woriters compensation - emp oyees x 25 rate 0.00 on a Unemployment - projected 26 employees x $7,000 x UCT-6 rate 0.00 SALARIES' a .. ag o Gross Annual on PropOaed rj a � .. � _>-� o/ Gross,Annual POSITION USTIIIIG selary� 0107 � � .. ! pa seuy .� Pasklon ! ab :, {AgenCyj� MER y 2 y esfed(C4A) . ' [3nrepNi'Fx+eiO(i�bi'eelai�J:/Olrs ar '.70,000.00 art -r".. , f0,a0a:00 , _. :.: , 7.14% srzumos 1 • Type the OrWaatian and Program Name Program Director/Administrator 10 hrs 7,800.00 7,800.00 7,800.0 100.00% Program Operations Manager 25 hrs. 15,500. 15,500.00 15,500.00 100.00% Institute Prevention Coordinator - 12 Hrs. 91360.00 9,360.00 9,360.00 100.00° (2) Institute TrainersfTeachers - 6 hrs. 4,212.00 4,212.00 4,212.0 100.00% #DIV/O! #DIVro! #DIV/O! #DIV/O! #DIV/0! #DIV/0! #DIV/0! #DIV/OI #DIV/O! #DIV/OI #DIVIO! #DIVIO! #DIVIO! #DIVIO! #DIV/D! #DIV/0! Remaining positions throughout agency en Total Salaries $36,872.00 $36,872.00 $36.872.001 100. 00% FRINGE BENEFITS DETAIL n (Funder SPeCl/IC Budget , . _ .r IK .�,,r s,� D , Vlbrker a 1lnemployme Total fringes Funder Column C only, - M4722 to 27T ? AX X 6 Compens. nt Compens. Specilfc ' - -. Position Tide/ TofalHrswR • '- bramph:. Case Marupar/10 frs 8250 X20000 -, X300.00 300.00 200.00 1,582.50 Program Director/Administrator 10 hrs 7,800.00 - 596.70 596.70 Program Operations Manager 25 hrs. 15,500.00 1 , 185.75 1 , 185.75 Institute Prevention Coordinator - 12 Hrs. 9,360001 716.04 716.04 (2) Institute Trainers/Teachers - 6 hrs. 4,212-001 322.22 322.22 0 0.00 0.00 0. 0 0 0.00 0.00 0.00 0 0.00 0.00 0.00 0 0.00 0.00 0.00 0 0.00 0.00 0.00 0 0.00 0.00 0.00 0 0.00 0.00 1 0.0 0 0.00 0.00 0.0 a 0.001 0.00 0.00 0 0.00 0.00 0.00 0 0.00 0.00 0.00 0 0.00 0.00 O.OGJ 0 0.00 0.00 0.0 0 0.00 0.00 0.00 0 0.00 0.00 0.00 0 0.00 0.00 0.00 Total Funder Request Fringe Benefits $36,872.00 $2,820.71 $0.00 $0.00 $0.00 $0.001 $2,920.71 9 ` C D _ 7 DtT ESt25Zw„ a m FunderSpeclfic Toto! /Igene ` � ra Badget Budged 27 Travel-Daily N ' w . # of Staff x average # of miles/wk x 50 vAcs x 4 $ = Estimated Daily TraveUMileage Reimb 28 TravellConferences/Training 514&4W5 8.1 1 7 � k YA Ly��i I i' •' `s✓ 4�ia d{ �A� ii h:�. 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E c x x F it o q M N E m w rn W d o. x E o g E w y 4 c q z m s c a � a A y c m q c x y o c `° w � 3 N x y� c W z o E m x x m Pl o+ = N m m 0 �' x C C m d 3 W p O Vi C C a 'c a a c E F .nE a m _ rn N a q c d+ x tC x ._ h m E 2 m (7 m �- w m 'm v m � e o LL `. m c m a c c a C m •q a x ' E c a n aai a m c n g t E m g' » d Z ui c C L d'• m "' a 6 P! iv _�' ` u w ' > ._ _ � _ m @ a m ._ � kk E o U o m o o c £ rn m m 'm 10 a '� � rn c rn m m ._ a �' a � l'L g _ a f � fi 'm 'c o � 2 w F- a mn c mam � >' m = m mca � p� = $ 10 a mco cm � q „ a - i c 4 � l4 e 2 c0ooL° a 3E '° `$ ocw c -E 'e $' o eto; EE c € — o a d •a m o c d d m E m �' ' .! £ = a m v v E m m a & E g °• 'n ?: v a v • q@ c m m d E » > > q m o c u c Lr m a Z F V �j E a p F # N Q a �J N m = W C� (J Q' a d J IL V N U VJ C O U m Q W U 2 U U � p�p Z LL V � U J p 6 J U V � m � LL • V V' A� A 1Se a � a • m ' ! a g ? or m 3 3 o fX Z m m n n x m a x N O N 4 - S h ' ' .,, , L 'Vi £ q f �{ :lei f A, t �,�, env ofi ' zif t' P ec J t t 5 ' ne T � . m N } IL S1 r W ` OOOp m F V O � O S 1 m _ N ` P W m N V O O ( 9 O O NEPOTISM STATEMENT The St. Peter's Human Services Agency , in the interest of good practices and sound judgment, refrains from hiring family members as listed in the Indian River County' s Nepotism Policy. The Agency' s Administrator and/or Board of Directors however , will as does the Indian River County Personnel Director, and as indicated in the Indian River County' s Nepotism Policy , at its discretion hire family members if it is determined in the best interest of the Agency . ! n I i AutNoFFi evo Principal No ry E5 a Date wrH L JEFFERSON MY COMMISSION C DO 199000 EXPIRES: May 6, 2007 - mima mu Ndr ywok undawnwis AFFIRMATION ACTION PLAN It is the policy of St. Peter' s Human Services, Inc. that no person shall on the basis of race , color, national origin , marital status or handicap, be excluded from participation in , or be denied the benefits of, or be subjected to discrimination under any program or activity receiving state financial assistance, or be so treated on the basis of sex under educational programs or activities receiving state assistance . ST. PETER' S HUMAN SERVICES , INC . BOARD OF DIRECTORS BOYS TRAINING AND DEVELOPMENT INSTITUTE A ADMINISTRATOR/ PROGRAM DIRECTOR rpt: . P.ROGRAM MANAGER INSTITUTE PREVENT INSTITUTE TRArnpmm O.ORDINATOR , ,,& , TEACHERS VOLUNTEERS MENTORS NOT FOR PROFIT AGENCY CERTIFICATION The County of Indian River requires, as a matter of policy, that any Consultant or firm receiving a contract or award resulting from the Request for Qualifications issued by the County of Indian River, Florida, shall make certification as below. Receipt of such certification, under oath, shall be a prerequisite to the award of contract and payment thereof. I (we) hereby certify that if the contract is awarded to me, our firm, partnership, or corporation , that no members of the elected governing body of Indian River County, nor any professional management, administrative official or employee of the County, nor members of his or her immediate family, including spouse, parents, or children, nor any person representing or purporting to represent any member or members of the elected governing body or other official, has solicited , has received or has been promised , directly or indirectly, any financial benefit, including but not limited to a fee, commission, finder's fee, political contribution , goods or services in return for favorable review of any Proposal submitted in response to the Request for Qualifications or in return for execution of a contract for performance or provision of services for which Proposals are herein sought. The undersigned certifies that he/she is a principal or officer of the firm applying for consideration and is authorized to make the above acknowledgments and certifications for and on behalf of the applicant. The undersigned certifies that the Applicant has not been convicted of a public entity crime within the past 36 months, as set forth in Section 287. 133, Florida Statutes . Failure to sign this form will resuk in draaualirrcation. Handwritten Signaty� of Authorized Principal(s): DATE: NAME: ' k i✓ >( 1�I i TITLE: _ NAME OF FIRM/PARTNERSHIP/CORPORATION: J FOR AND ON BEHALF OF THE APPLICANT: Sworn to and subscribed to e, Notary u lic, this i7 ay of 006. BY: �. (S ) (TYPE NAME & TITLE) ,. ,°•,yam.. RUMLJEFFEABON MY COAMAISSION i OD 1990f 0 IXP IS 1 8, 2007 m�aa miu�Welt UrEwwnrs SWORN STATEMENT UNDER SECTION 105.08, INDIAN RIVER COUNTY CODE, ON DISCLOSURE OF RELATIONSHIPS THIS FORM MUST BE SIGNED IN THE PRESENCE OF A NOTARY PUBLIC OR OTHER OFFICER AUTHORIZED TO ADMINISTER OATHS. 1 . This sworn statement is submitted with RFP No. 2006061 for Village of Excellence Training Institute for Girls. 2. This sworn statement is submitted by: St. Peter's Human Services. Inc. (Name of entity submitting Statement) whose business address is : 4250 38" Avenue, Vero Beach, FL 32967 and (if applicable) its Federal Employer Identification Number (FEIN) is 31 -1480633 (If the entity has no FEIN, include the Social Security Number of the individual signing this sworn statj�me% 3. Myna eis Andrew Jefferson (Please print name of individual signing) and my relationship to the entity named above is President. 4 . 1 understand that an "affiliate" as defined in Section 105. 08, Indian River County Code, means: The term "affiliate" includes those officers, directors, executives, partners, shareholders, employees, members , and agents who are active in the management of the entity. 5. 1 understand that the relationship with a County Commissioner or County employee that must be disclosed as follows: Father, mother, son, daughter, brother, sister, uncle, aunt, first cousin , nephew, niece, husband, wife , father-in-law, mother-in-law, daughter- in-law, son-in-law, brother-in-law, sister-in-law, stepfather, stepmother, stepson , stepdaughter, stepbrother, stepsister, half brother, half sister, grandparent, or grandchild . 6. Based on information and belief, the statement, which I have marked below is true in relation to the entity submitting this sworn statement. [Please indicate which statement applies.] Neither the entity submitting this sworn statement, nor any officers, directors, executives , partners, shareholders , employees , members, or agents who are active in management of the entity, have any relationships as defined in section XIII AUTHORIZATION FOR RELEASE OF INFORMATION Indian River County and St. Peter's Human Services. Inc. (Agency/Individual are in the process of negotiation of a contract for Village of Excellence Training Institute for Girls Indian River County is authorized to make an investigation of the Agency/Individual regarding its experience and qualifications. The Agency/lndividual authorized the release of all relevant information concerning prior services fumished, contracts and background information of the Agency/individual. The Agency/Individual authorizes any individual or organization that is in possession of relevant factual contract and background information, to release such data to Indian River County in response of the County's request. When an individual employee of the Agency signs Authorization for Release of Information, such individual authorizes the County to obtain relevant background information concerning such employee's criminal record, if any, and such other information that may be relevant to employee's good character and work experience. Authorization is given here by the Agency/Individual and such employees who execute this authorization with the understanding and limitation that Indian River County will utilize the information obtained for the purposes set forth herein and that such information shall not be disclosed to third parties except as provided by law. Name Agency/Individual St. Peter's Human Services , Inc. Print name Name Employee Providing authorization Andrew Jefferson ,. nt name Signature (in blue ink) Date May 23, 2006 XII 105. 08, Indian River County Code, with any County Commissioner or County employee. X The entity submitting this sworn statement, or one or more of the officers, directors, executives , partners, shareholders, employees, members, or agents, who are active in management of the entity have the following relationships with a County Commissioner or County employee: Name of Affiliate Name of County Commissioner Relationship or entity or emoloyee St. Peter's Human Rosemary Teague Sister-in-law Services , Inc. (County Employee) XIV signature) May 23, 2006 (date) STATE OF Florida COUNTY OF INDIAN RIVER COUNTY Theforegoing instrumen was acknovv edged before me this aciday of 2006, by ��C{Po'; !tet N-,\ who is personally known tome or who h produced as identification . NOTARYrP BLIC PRINT: "Ruth Jeffe o State of Florida at Large ` I My Commission Expires: l (Seal) RUiH L N SO r MYCOMMISSIONIDO1WID :. EXPIRES: May 6, 2007 m&d7lwuNb gPtftUWWAMM � • Xv SUPPORTING DOCUMENTS CHECKLIST RFP 2006061 Cover Page Application List of current officers and directors Latest Financial Audit Report & Management Letter that conforms with the AICPA Audit Guide Most recent IRS Form 990, including all schedules Most recent Internal Financial Statement (i .e. : Balance Sheet and Operating Budget Staff Organizational Chart Most Recent Annual Report (if available) 501 (C)(3) IRS Exemption Letter Articles of Incorporation Agency's Bylaws Agency's written policy regarding Affirmative Action Nepotism Statement Taxonomy Definition for each program XVI lOrgaLbation: St. Peter's Human Services, Inc. Program: St. Peter's Boys Development & Training Institute Founder. Children's Service Council ORGANIZATION: St. Peter's Human Services. Inc. PROGRAM: St. Peter's Boys Development & Training Institute 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. % I Section of the Proposal Pa e # X TABLE OF CONTENTS (check list) 1 -2 X COVER PAGE (with signatures). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 X A. ORGANIZATION CAPABILITY (one page maximum) X 1 . Mission and Vision of organization. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 X 2. Summary of expertise, accomplishments, and population served . . . . . . . . . . . . . . . . 4 X B. PROGRAM NEED STATEMENT (one page maximum) X 1 . Program Need Statement. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 X 2. Programs that address need and gaps in service . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 X C. PROGRAM DESCRIPTION (two pages maximum) 1 . Funding priority . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 _ 2. Description of program activities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-7 _ 3 . Evidence that program strategy will work. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 — 4. Staffing. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 _ 5 . Awareness of program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . 8 6 . Accessibility of program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 X D. MEASURABLE OUTCOMES (two pages maximum) . . . . . . . . . . . . . . . . . . . . . . . . . 10 X E. COLLABORATION (one page maximum) . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . 11 X F. PROGRAM EVALUATION (two pages maximum) 1 . Demographics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 2. Measures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 _ 3 . Reporting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 . . . . 12- 13 X G. TIMETABLE (one page maximum) . . . . . . . . . . . . . . . . . . . . . ... .. . . . . . . . . . . . . . . . . . . . . . 14 X H. UNDUPLICATED CLIENT COUNT 1 . Projections by Location . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 2. Projections by Age Group . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 1 • organization: St. Peter's Human Services, Inc. Program: St. Peter's Boys Development .$ Training Institute Founder. Children's Service Council X I. BUDGET FORMS 1 . Financial Budget Forms. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 X J. FUNDER SPECIFIC/ADDITIONAL SHEETS X K APPENDIX 2 5 • Poe T ,1T �m Name &&#4J UNIFORM GRANT APPLICATION BUDGET NARRATIVE WORKSHEET IMPORTANT: The Budget Narrative should provide details to justify the amount requested in each line item of the budget for your program. From this worksheet, your figures will be linked to the Total Agency Budget, Total Program Budget and Funder Specific Budget Forms. AGENCY/PROGRAM NAME : Boys Development & Training Institute FUNDER: Children's Services Council _ . . — • • — . . — . . _ . . _ . . — . . _ . . — • - - . . _ . . — — . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . _ . . I 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 Vibe used for calculations and to write information only. 9R"Y ^R A FOR Proposed eatcunmNs( Pro osed Funders Specific Total AgeREVENUES PQW USEONLY Tofaf Program ncy (SOWOENLS, tBudget Budget Budge 1 Children's Services Council-St. Lucie 2 Children's Services Council-Martin 3 Advisory Committee-Indian River 61 ,386.71 61 ,386.71 61 ,386.71 4 United Way-St. Lucie County 5 United Way-Martin County 6 United Way-Indian River County 7 Department of Children & Families 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 In-Kind Donations (Not included in total) 20 TOTAL REVENUES (doesnR include line 19) $61 ,386.71 $61 ,386.71 $61 ,386.71 4 B C D , EXPENDITURES O� FOR Proposed Total Program Funder Specific , Total Agency (BROW C,LLWLATON81 Budget ,: " Budget IBudget 21 Salaries - (must complete chart on next page) 36,872.00 36,872.00 36,872.00 Salary,,, 22 FICA - Total salaries x 0.0765 7.65% 2,820.71 2,820.71 2,820.71 Retirement - Annual pension tor qua ie 23 staff 0.0 Life/Health - e iZa en or - efm 24 Disab. Workers Compensation - 0.00 employees x �;, , 25 rate 0.00 Florida nemp oymen - prolec 26 employees x $7,000 x UCT-6 rate 0.00 A 8 SALARIES % o Grass :4nrival portlorr of Sala % C aofGrOSSAnnual - POSITION LISTING Salary iy on Proposed Position Tlde/ Tota! Nrs/wk' Program Funder Specific Budget Salary . ,(Agenryl `equested(CIA) Example: Executive Owtorl40hB 70,000,001 10,000.00 1 5,000.00 7:14% 6!&2006 B-1 Type the Organization and Program Name • National Conference (cost per staff) • Training/Seminar (cost per staff) - - Other Trainings (cost of travel, lodging, registration, food) 29 Office Supplies - Office supplies (monthly average x 12 months = estimated cost of office supplies based on present history. 30 Telephone # Phone lines x average cost per month x 12 months = local phone cost • Average long distance calls x 12 months = Estimated cost of long distance 41 31 Postage/Shipping • Quarterly Mailing of Newsletter • Special events, etc. '. • Bulk mailings - appeals 32 Utilities • Electricity ($ x 12 months) - • Water/Sewer ($ x 12 months) - Garbage ($ x 12 months) 33 Occupancy (Building & Grounds) • Mortgage/Rent ($ x 12 months) • Janitorial ($ x 12 months) • Grounds Maint. ($ x 12 months) • Real Estate Taxes 34 Printing & Publications • Quarterly Newsletter ($ x 4) • Letterheads, Envelopes, etc. • Fundraising materials - Other 35 Subscription/Dues/Memberships - Membership to National Organization • Dues • Subscriptions to Newspapers/magazines, etc. 36 Insurance • Directors/Officers Liab. - Commercial/General Insurance • Bond Ins. • Auto Insurance 37 Equipment: Rental & Maintenance 'r , • Copier lease ($ x 12 months) • Meter lease ($ x 12 months) • Copier Maintenance ($ x 12 months) • Computer Maintenance ( $ x 12 months) • Other 38 Advertising 500.00 500.00 500.00 • Newspaper ads • Fundraising ads/promotions • Other (vacancies) 39 Equipment Purchases: Capital Expense • Computer/monitor (# x $) • Laser Printer 40 Professional Fees (Legal, Consulting) • Legal advice ( estimated #hrs x $) „ > • Consultant fees • Other 41 Books/Educational Materials 1 ,000.00 1 ,00000 1 ,000.00 • Books/videos • Materials ($ x staff) ` 42 Food & Nutrition 16,094.00 16,094.00 16,094.00 rv812006 B-t T,„ nl�ml. .a �N> UNIFORM GRANT APPLICATION TOTAL AGENCY BUDGET AGENCY/PROGRAM NAME: FY 0405 FY 05106 =PROP�OSEDJCO. INCREASE FYE FYE RRENT VS. FY BUDGET A B D ACTUAL TOTAL 01. apcol. 6REVENUES BUDGETED 1 Children's Services Council-St. Lucie #DIV/O!2 Children's Services Council-Martin #DIV/0!3 Adviso Committee-Indian River #DIVl0! 4 United Way-St. Lucie County 0.001 #DIV70! 5 United Way-Martin County 0.00 #DIVIO! 6 United Way-Indian River Coun 0.00 #DIVIO! 7 Department of Children & Families 0.00 71DIV/01 a CountyFunds 0.00 #DIV/0! 9 Contributions-Cash 0.00 #DIV/Ol to Program Fees 0.00 #DIV/01 ii Fund Raisin Events-Net 0.00 #DIV/0! 12 Sales to Public-Net 0.00 #DIVI01 13 Membershi Dues 0.00 #DIV/0! 14 Investment Income O.DO #DIV10! is Miscellaneous 0.00 #DIV/01 is Legacies & Bequests 0.00 #DIV/01 17 Funds from Other Sources 0.00 #DIV101 1s Reserve Funds Used for Operating 0.00 #DIV101 is In-Kind Donations (NO mau4m In tob ) 0.00 #DIVIO! 20 TOTAL 0.00 0.00 61,386.71 #DIV/OI EXPENDITURES 21 Salaries 36872.00 #DIV/01 22 FICA 2820.71 #DIV/0! 23 Retirement 0.00 #DIV/0! 24 Life/Health O.OD #DIV/01 25 Workers Compensation 0.00 #DIV/0! 26 Florida Unem to meet 0.00 #DIVIO! 27 Travel-Dail M0.0D #DlVf01 VI01 29 TravellConferences/Trainin IV/01 29 Office Supplies IV/01 3o Telephone IV/01 31 Postage/ShippingIV/0! 32 Utilities IV/0133 Occu an Buildin & Grounds IV/0134 Printin & Publications IV70!3 5 Subscri tion/Dues/Membershi s IVIO! 36 Insurance 0.00 #DIV/0! 37 E ui ment:Rental & Maintenance 0.00 #DIV/0! 3s Advertising 500.00 #DIV/0! 39 Equipment Purchases:Ca ital Expense 0.00 #DIV/0! 40 Professional Fees (Legal, Consulting) O.OD #DIV101 41 Books/Educational Materials 1000.00 #DIVI01 42 Food & Nutrition 16094 00 #DIVI01 43 Administrative Costs 0.00 #DIV/O! 44 Audit Expense 1,500.001 #DIV/O! 45 Specific Assistance to Individuals 0.00 #DIVI01 46 Other/Miscellaneous 2600.00 #DIV/0! 47 Other/Contract 0.00 #DIV/01 4a TOTAL 0.00 0.00 61,386.71 #DIV/01 49 REVENUES OVER/ UNDER EXPENDITURES 0.00 0.00 0.00 #DIV/01 GAMH B ' Type the Organization and Program Name UNIFORM GRANT APPLICATION FUNDER SPECIFIC BUDGET PROGRAM EXPENSES AGENCY/PROGRAM NAME: FUNDER: A B C FY 06107 FY 06107 % OF TOTAL FUNDER TOTAL VS. PROGRAM SPECIFIC FUNDER REQUEST BUDGET BUDGET (col. B/col. A) EXPENDITURES 21 Salaries 36,872.00 36,872.00 100.00% 22 FICA 21820.71 21820.71 100.00% 23 Retirement 0.00 0.00 #DIV/01 24 Life/Health 0.00 0.00 #DIV10 ! 25 Workers Compensation 0.00 0.00 #DIV/0 ! 26 Florida Unemployment 0.00 0.00 #DIV/01 27 Travel-Dail 0.00 0.00 #DIV101 28 Travel/Conferences/Training 0.00 0.00 #DIV/01 29 Office Supplies 0.00 0.00 #DIV/01 30 Telephone 0 .00 0.00 #DIV/01 31 Postage/Shipping 0 .00 0 .00 #DIV/0 ! 32 Utilities 0 .00 0 .00 #DIVIO ! 33 Occupancy (Building & Grounds 0 .00 0 .00 #DIVIO ! 34 Printing & Publications 0 .00 0 .00 #DIVIO ! 35 Subscription/Dues/Memberships 0.00 0 .00 #DIV/0 ! 361nsurance 0.00 0 .00 #DIV/01 37 Equipment: Rental & Maintenance 0.00 0 .00 #DIV/0 ! 38 Advertising 500.00 500 .00 100 .00% 39 Equipment Purchases : Capital Expense 0.00 0 .00 #DIV/0 ! 40 Professional Fees (Legal, Consulting) 0.00 0.00 #DIV/01 41 Books/Educational Materials 1 ,000.00 13000.00 100.00%, 42 Food & Nutrition 16,094.00 167094.00 100.00% 43 Administrative Costs 0.00 0.00 #DIV/0 ! 44 Audit Expense 11500.00 17500.00 100.00% 45 Specific Assistance to Individuals 0.00 0.00 #DIV/01 46 Other/Miscellaneous/Fuel Transportation 2g600.001 2,600.001 100.00% 47 Other/Contract 0.00 0.001 #DIV/0 ! 48 TOTAL $61 ,386.71 $61 ,386.71 100.00% s arzggs 84 e T eMe Orgwtr n Pmvm Na UNIFORM GRANT APPLICATION EXPLANATION FOR VARIANCES OF 15% OR MORE FUNDER SPECIFIC BUDGET AGENCYIPROGRAM NAME: FUNDER: Salaries FICA #DN/0! #DN101 #DIV/01 #DIV/01 #DIVf0! #DN/01 #DrV/01 #DIV/01 #DN/01 #DIV/01 #DIVIO! #DN/til #DIV/0! #DIV/0! #DIVIO! Advertisin #DIVI01 #DNIO! BookslEducational Materials Food S Nutrition #DIVt0I Audit Exoense ADN/O! Other/Miscellaneous/Fuel Trans ortat!on #DIV101 warzme 94 *w. ne 019W Q, Wd Pa s..a UNIFORM GRANT APPLICATION EXPLANATION FOR VARIANCES OF 15% OR MORE TOTAL PROGRAM BUDGET AGENCYIPROGRAM NAME: FUNDER: #DN70! . #DIVIO! #DN101 #DIVIO! #DIVI01 #DIVIO! #DIVIO! #DN101 #DIV101 #DIVIO! #DIV101 #DIVIO! #DN/O! #DN101 #DIVIO! #DMO! #DM01 #DN/O! #DN101 #D V101 #DMO! 11DIV101 #DIVI01 #DIV/O! #DIV/01 #DMO! #DN/O! #DN/01 #DN101 #DIVIO! #DN/01 MIMI Represents funds needed to pmvide meals for the children including, dinner, breakfast and lunch each week for 52 weeks. #D 11101 #13M01 #DNI01 #DIVI01 Represents fuel costs each week at $50. for 52 weeks. Program now pmviding pick up and dmp off services for students. #D11101 #DIVI01 #DIV10l #DIV101 11DIVI01 #DIVI01 #DM01 #DN101 #DIV/01 #DN/01 6Ib2005 eb Tn, n.w ,o UNIFORM GRANT APPLICATION TOTAL PROGRAM BUDGET AGENCY/PROGRAM NAME: FY 04105 FY 05106 FY 06107 % INCREASE FYE FYE FYE_ CURRENT VS. NEXT FY BUDGET A B C D ACTUAL TOTAL PROPOSED (col. c<n. Inicol. B REVENUES BUDGETED BUDGETED 1 Children's Services Council-St. Lucie 0.00 #DIV/01 2 Children's Services Council-Martin 0.00 #DIV/01 3 Advisory Committee-Indian River 6138671 #DMO! 4 United Wa St. Lucie County 0.00 #DIV10! 5 United Way-Martin County0.001 #DIVl01 6 United Wa -Indlan River County 0.001 #DIV/01 7 Department of Children & Families 0.0131 #DIV/0! 6 County Funds 0.001 #DIVI01 s Contributions-Cash 0.001 #DIV/01 10 Program Fees 0.00 #DIV/Ol 11 Fund Raising Events-Net 0.00 #DIV/01 12 Sales to Public-Net 0.00 #DIV/01 13 Membership Dues 0.00 #DIVI01 14 Investment Income 0.00 #0I701 15 Miscellaneous 0.00 #DMO! is Legacies & Bequests 0.00 #DIV10! 17 Funds from Other Sources 0.00 #DIV/01 is Reserve Funds Used for Operating 0.00 #DMO! 1s In-Kind Donations (Not included in snap 0.001 #DIV/0! 20 TOTAL 0.00 0.00 61 386.71 #DIV/0! EXPENDITURES 21 Salaries 3687200 #DIV/01 zz FICA 29820.71 #DIV/01 23 Retirement 0.00 #DIVIO! 24 Life/Health 0.00 #DIV101 25 Workers Compensation 0.00 #DIV/01 26 Florida Unemployment 0.00 #DIV/O! 27 Travel-Dail 0.00 #DIV/01 26 TravellConferences/Trainin 0.00 #DIVI01 29 Office Supplies 0.00 #DIV101 30 Telephone 0.00 #OIV70! 31 Posta a/ShI !n 0.00 #DIVI01 32 Utilities 0.00 #DIV/01 33 Occupancy (Building & Grounds 0.00 #DIV/0! 34 Printing & Publications ILOOI #DIVI01 35 Subscri tionlDues/Membarshl s 0.00 #DIV/01 36 Insurance 0.00 #DIV/01 37 E ul ment:Rental & Maintenance 0.00 #DIV/01 36 Advertising 500.00 #DIV/0! 36 Equipment Purchases:Ca ital Expense 0.00 #DIV/0! ao Professional Fees (Legal, Consulting) - 0.00 #DIV/0! 41 Books/Educational Materials 1 000.00 #DIV/01 42 Food & Nutrition 16 094.(10 #DMO! 43 Administrative Costs 0.00 #DIV701 44 Audit Expense 1 .500.00 #DIV/01 45 Specific Assistance to Individuals 0.00 #DIV/D! 46 OtherlMiscellaneous 260000 #DIV/01 47 OtherlContract 0.00 #DIV/01 46 TOTAL 0.00 0.00 6138671 #DIV/0! 49 REVENUES OVER/ UNDER EXPENDITURES 0.00 0.00 0.00 #DIV/01 wrzms ea Type the Organization and Program Name ` • Meals ( # meals x clients x 5days x 50 wks) • Snacks 43 Administrative Costs Admin. Cost (% of total budget) . 44 Audit Expense 1 ,500.00 1 ,500.00 1 ,500.00 • Independent Audit Review 45 Specific Assistance to Individuals • Medical assistance • Meals/Food • Rent Assistance • Other 46 Other/Miscellaneous 2,600.00 2,600.00 2,600.00 • Background check/drug test • Other/Transportation 47 Other/Contract • Sub-contract for program services - 46 TOTAL EXPENSES $61 ,386.71 $61 ,386.71 $61 ,386.71 6W00s B-0 Type the Organization and Program Name - Program Director/Administrator 10 hrs 7,800.00 7,800.00 7 ,800.00 100.00°/ Program Operations Manager 25 hrs. 15,500.00 15,500.00 15,500.00 100.00% Institute Prevention Coordinator - 12 Hrs. 9,360.00 9,360.00 9,360.00 100.00% (2) Institute TrainersTreachers - 6 hrs. 4,212.00 4,212.00 4,212.00 100.00% #DIV/0! #DIV/O! #DIV/0! #DIV/O! #DIVIO! #DIV/0! #DIVIO! #DIV/0! #DIV/0! #DIV/0! #DIVIO! #DIVIO! #DIVIO! #DIVIO! #DIV/0! #DIV/0! Remaining positions throughout the agency Total Salaries $36,872.00 $36,872.00 $36,872.0 100.00% FRINGE BENEFITS DETAIL A (Funder Specific Budgetrender B 0 v E F c Pension Worker's Unemptoyme Total Fringes Funder Column C only, from line 22 to 27 SPecIRc FICA L85% it fns. Budgef (A_x %) Compens. rn Compens. Specific Position Title /Total Hrslwk ' Example: Case ManagerlOhna 4000.00 382.50 - 200.00 .500.00 300.00 200.00 91582.50 Program DirectorlAdministrator 10 hrs 7,800.00 596.70596.7 Program Operations Manager 25 hrs. 15,500.00 1 ,185.75 1 , 185.751 Institute Prevention Coordinator - 12 Hrs. 9,360001 716.04 716.04 (2) Institute Trainerslfeachers - 6 hrs. 4,212-001 322.22 322.2; 0 0.00 0.00 0.0 0 0.00 0.00 0.0 0 0.00 0.00 0.0 0 0.00 0.00 0.0 0 0.00 0.00 0.0 0 0.00 0.00 0.0 0 0.00 0.00 0.0 0 0.00 0.00 0.0 0 0.001 0.00 0.0 0 0.001 0.00 0,0( D 0.00 2.00 0.0 0 0.00 0.00 0.0 0 0.00 0.00 0.0 0 0.00 0.00 0.0 0 0.00 0.00 0.0 D 0.00 0.00 0.0 Total Funder Request Fringe Benefits $36,872.00 $2,820.71 $0.00 M001 $0.001 wool 2,820.71 A 6 C D' EXPENDITURES 6RAYAaEAS Proposed Total Program Funder Specific ; Total Agency AGENCY YAE ONLY TO ' eNGw{�a1A.. Budget Budge! Budget 27 Travel-Daily # of Staff x average # of miles/wk x 50 wits x ' " £ _ •• $ = Estimated Daily Travel/Mileage Reimb. 28 Travel/Conferences/Training 1 " &Bao 6 9.1