Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
2004-229E (2)
� � • t 2 - vel ✓ A 7 = tm ot1. gU Indian River County Grant Contract This Grant Contract ("Contract") entered into effective this 1st day of October 2004 by and between Indian River County, a political subdivision of the State of Florida , 1840 25th Street , Vero Beach FL , 32960 ("County") and Exchange Club Castle , (" Recipient") ; of: Exchange Club Castle P . O . Box 12908 Fort Pierce , Florida 34979 Safe Families Program Background Recitals A. The County has determined that it 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 proposals 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 (as 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 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 2004/2005 ("Grant Period") . The Grant Period commences on October 1 , 2004 and ends on September 30 , 2005 . - 1 - 4 . Grant Funds and Payment The approved Grant for the Grant Period is Thirty Thousand Dollars ($30 , 000) . The County agrees to reimburse the Recipient from such Grant funds for actual documented costs incurred for 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 Obligations 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 written notice . 5 . 2. Compliance with Laws . The Recipient shall comply at all times with all applicable federal , state , and local laws , rules , and regulations . 5 . 3 Quarterly Performance Reports , The Recipient shall submit Quarterly 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 the 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 a 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 it's 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 this 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 September 21 , 2004 , provide to the 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 : - 2 - ( i ) Commercial General Liability Insurance in an amount not less than $ 1 ,000 , 000 combined single limit for bodily injury and property damage , including coverage for premises/operations , products/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 ) Workers' 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 to the County. In addition , the County may request such other proofs and assurances as it may reasonably 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 Workers ' 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 COUNTY COMMISSIONERS By: .lam • _ rix�G Caroline D . Ginn , Chairman BCC Approved : At arton, Cie*% %, By: � U�fdy-J 1'004 bepputyy Clerk PAI IA M ,- 8 DGICLY Approved Couci # rafbr ov a and leal sufficiency: arian L Fell , ssistant my orney RECIPIENT: By: 4, Exchange lub Castle 4 - S EXHIBIT A [Copy of complete proposal/application] - 1 - Organization: Exchange Club CASTLE Program Name : Safe Families Funder: Children' s Services Advisory Conunittee RFP #6067 PROGRAM COVER PAGE Organization Name : Exchange Club CASTLE Executive Director: Theresa Garbarino-May E-mail : tgarbarino -maypexchangecastle . org Address : PO Box 12908 Telephone : 772-465 -6011 Fort Pierce, FL 34979 Fax : 772-465 - 6013 Program Director : Ruth Orenstein E-mail : rorensteinna ,exchangecastle . org Address : 673 U. S . 1 Telephone : 772- 567- 5700 r Vero Beach, FL 32960 Fax : 772 -567-7133 Program Title : Safe Families Priority Need Area Addressed: Focus Area II : Parental Support and Education Brief Description of the Program : Taxonomy # PH-610 . 680 (Parenting skills development program) . Safe Families is a home based parent education and support program designed to prevent child abuse and neglect and help families remain intact Through long term up to one year) intensive (at least weekly) visits from a counselor, families learn to reduce risk factors associated with abuse and neglect, and increase the protective factors associated with non- abusive caring and stable families SUMMARY REPORT — (Enter Information In The Black Cells Only) Amount Requested from Funder for 2004 / 05 : $ 49 , 904 . 50 Total Proposed Program Budget for 2004 / 05 : $ 215 , 221 . 32 Percent of Total Program Budget : 23 . 2 % Current Funding ( 2003 / 04 ) : $ 35 , 000 Dollar increase / ( decrease ) in request : $ 14 , 905 Percent increase / ( decrease ) in request * : 42 . 6 % Unduplicated Number of Children to be served Individually : 148 Unduplicated Number of Adults to be served Individually : 123 Unduplicated Number to be served via Group settings : _ Total Program Cost per Client : * * 794 . 17 * If request increased 5 % or more, briefly explain why: Addition of . 5 counselor position due to increased demand for services . * * 82 families will be served at a total cost per family of $ 2 , 625 . If these funds are being used to match another source, name the source and the $ amount : United Way of Indian River County: $ 93 , 060 ; United for Families : $ 60 , 257 . The Organization 's Board of Directors has approved this application te). 4/ 04 Al Fort Name of President/Chair of the Board Sign e Theresa Garbarino-May. 2 Name of Executive Director/CEO - iznature 3 Organization: Exchange Club CASTLE Program Name : Safe Families Funder: Children ' s Services Advisory Committee RFP #6067 PROPOSAL NARRATIVE A. ORGANIZATION CAPABILITY (Entire Section A not to exceed one page) 1 . Provide the mission statement and vision of your organization . The mission of the Exchange Club CASTLE is to improve the quality of family life while preventing child abuse and neglect, by providing community education, support and resources for families in need of assistance . The CASTLE envisions a community where each child is allowed to grow to his or her full potential, free from abuse and neglect, and families have access to the supports they need to create health livin and learnin environments for children. 2 . Provide a brief summary of your organization including areas of expertise, accomplishments, and population served. The CASTLE began in 1981 , and now serves as the model for a national network of child abuse prevention centers that span 107 locations in 27 states . With an involved, active Board of Directors , and an Executive Director, Theresa Garbarino -May, who is beginning her 181h year at the helm of the agency, the CASTLE is known for its steady leadership and quality programs . The CASTLE received national accreditation this year from the Council on Accreditation. This distinction ensures that the CASTLE "meets the highest national standards for professional practice" in its programs and services . The CASTLE also received recognition for its Valued Visits program, which was selected to be the featured program at the Violence Against Women' s Office conference this year in Duluth, Minnesota. The CASTLE offers an array of services designed to prevent child abuse, and cultivate the parent-child relationship . Our core program Safe Families , offers long term, home based, parenting skills development. Other programs offered by the CASTLE include : Families First, a training seminar for divorcing parents ; High Hopes for Kids , offering support to children whose parents have divorced; Positive Parenting, a support group for parents facing difficulties raising their children ; Healthy Families , providing home based services to pregnant women and newborns ; Valued Visits , a supervised visitation center, and our newest program, Co-Parenting, a support group aimed at helping divorced parents reduce conflict surrounding shared custody. CASTLE services utilize best practices, and a continuous quality improvement model . The population served is : families who are at risk for abusing or neglecting their children ; families who have had a reported incident of abuse or neglect, but who , with support and education, can eliminate further episodes of abuse ; families with children 0- 18 ; and families who live within Indian River County. This year ' s demographics indicate that 44% of enrolled families are single mothers or fathers, 60% are White, 19 % are Hispanic and 21 % are Black. 73 % of enrolled parents are under 40 years old. 4 Organization: Exchange Club CASTLE Program Name : Safe Families Funder: Children ' s Services Advisory Committee RFP #6067 Be , PROGRAM NEED STATEMENT (Entire Section B not to exceed one page) 1 . a) What is the unacceptable condition requiring change ? b) Who has the need ? c) Where do they live? d) Provide local, state, or national trend data, with reference source, that corroborates that this is an area of need. What: The unacceptable condition requiring change is child abuse and neglect . Child abuse and neglect has well-documented, long term, harmful effects on children, including permanent physical injuries, chronic low self esteem, developmental delays, difficulty in forming attachments and relationships, mental illness, aggressive behavior, and a cycle wherein an abused child is much more likely to , in turn, abuse his or her own children. ' Who has the need : Parents who pose a risk to their children, because of identifiable risk factors such as poverty, a lack of parenting knowledge and skills , or a parent ' s own history of abuse or addiction. Where : Last year, parents were served in all parts of Indian River County, Provide Data : The overwhelming majority of families that abuse or neglect their children can, with the proper support, learn to parent in a manner that is non abusive (research shows that home based parent education is the most effective way to prevent abuse and neglect") . This allows the family to remain intact and avoid the trauma of an out of home placement for the child. Research indicates that 96 -98 % of families who engage in home-based parent education programs such as Safe Families , do not re-abuse their children . This reduces by almost two- thirds , the number of children who face further abuse at the hands of their caretakers . "' Keeping a family intact eliminates the need for a foster care placement, where a child is three times more likely to be abused in state care as compared to remaining with parents . '" Locally, Indian River County had 1 ,039 abuse reports filed in 2002-2003 . This is a 7 % drop from the previous year, and better than the statewide drop of 3% . The rate of abuse in Indian River County is 17 children per 1 , 000, which is lower than the state rate of abuse (20 children per 1 , 000) but higher than the national average ( 12 children per thousand) . " In conclusion, the data show that 1 ) home based parent education prevents abuse, 2) home based parent education helps children stay out of foster care (where they are more likely to be abused), 3 ) Indian River County is doing better than the state at protecting its children, but worse when compared to national statistics, 4) with more home based parent education, Indian River Sounty can make a significant impact in reducing the number of children abused . 2 . a) Identify similar programs that are currently serving the needs of your targeted population ; b) Explain how these existing programs are under-serving the targeted population of your program. There are no similar programs serving the population targeted for Safe Families . The other child abuse prevention program in the county is Healthy Families, which serves a different population (pregnant moms and newborns) . The target population for Safe Families is underserved . This is evidenced by the fact that the program is receiving twice as many referrals as it can handle . 5 Organization: Exchange Club CASTLE Program Name: Safe Families Funder: Children ' s Services Advisory Committee RFP #6067 C . PROGRAM DESCRIPTION (Entire Section C, I — 6, not to exceed two pages) 1 . List Priority Needs area addressed. : Focus Area II : Parental Support and Education 2 . Briefly describe program activities including location of services . 1 . Upon receiving a referral, a counselor visits the family, and assesses the need for home-based parent education (Safe Families) . This is accomplished through interview, observation, and completion of an initial needs assessment. To avoid duplication or overlap with other service providers, a review is done of all services being offered to the family. When necessary, and with consent, other service providers are contacted in order to coordinate services to the family. If eligible for Safe Families , the family will begin a program of regular visits, and a family plan, including specific goals, will be developed. The family is an active participant in this process, collaborating on the initial plan for services . 2 . Once a family plan is developed, the counselor makes weekly visits to address the family plan goals . Weekly visits take place for up to one year, with the visits taking place in the family ' s home, thus increasing the counselor ' s ability to assess the safety of the children, and evaluate improvements made by the family. Parents remain active participants during the weekly visits , teaming with their counselor to initiate improved parenting techniques . 3 . During the weekly visits, counselors use a multifaceted approach to teaching, including utilizing parenting videos , working through parenting programs , creating behavior management plans , and establishing family meetings , or other formalized methods to improve family communication. Positive discipline, and family stability are two over-arching goals . 4 . All weekly visits are geared toward reducing risk factors (characteristics that increase the likelihood that abuse will occur) , and increasing protective factors (characteristics that decrease the likelihood that abuse will occur) . Safe Families has identified the following risk and protective factors that form the basis of each counselor' s work with a family : Risk Factors: Lack of parenting knowledge/skills; Parent 's past history of abuse,- Parent 's buse,Parent 's history of drug or alcohol abuse, or mental health issues; Poverty/financial stress; Teen and young parent; Social isolation. Protective Factors: Housing stability; Delay of subsequent pregnancy; Enrollment in childcare and health care; Livable wage employment,% Involvement in child 's school. 5 . Families are tracked for one year after exit from Safe Families to determine if abuse or re- abuse has occurred. 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 stated need or problem is child abuse and neglect. Safe Families addresses child abuse and neglect by offering long term, home based, parent education and support to build on the parent ' s knowledge of child development, positive discipline, communication, behavior modification, and nurturing and bonding . The family ' s relationship with their counselor is a critical element to the success of the program . Over the course of the program, the counselor guides, supports, coaches and teaches the parent to create a nurturing, healthy environment for their children. Initially, risk factors are identified, and addressed, and then protective factors are built upon, so that the family can remain stable and abuse free long after they graduate from Safe Families . 6 Organization: Exchange Club CASTLE Program Name : Safe Families Funder: Children ' s Services Advisory Committee RFP #6067 Here are conclusions from four independent studies that demonstrate the effectiveness of the home-based model of preventing child abuse and neglect (references on pg. 30) : "There is strong evidence to recommend home visitation to reduce child maltreatment "Home visiting has a higher retention rate (70-90%) than center-based services (60-70%) . "The positive effects of early home visitation re-emerge when the children reach age 85 )""' "In Pinellas County Florida, parents enrolled in a home visiting program had abuse rates of 1 . 6% as opposed to non-enrollees who had a rate of 4 . 9 % . " 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) . Safe Families Supervisor — 20 hours/wk —Required credentials/exp . — BA/2yrs . sup . exp . Safe Families counselors (2 . 5 FTE) - 40 hours/wk — Req. credentials/experience — BA/2 years Secretary — 40 hours/wk — Required credentials/experience — 1 -year experience . Human Resource staff — 5 hours/wk. -Required training — 3 yrs . experience . 5 . How will the target population be made aware of the program? Families are made aware of the program through the following methods : Referrals from agencies , schools, parents and the Department of Children and Families (now United for Families) . The CASTLE participates in local outreach efforts and information sharing events . The CASTLE participates in National Child Abuse Prevention Month, The CASTLE affiliates with many local businesses through fund raising and service clubs . The CASTLE ' s speaker ' s bureau does informational talks and trainings . The CASTLE is a First Stop site. The CASTLE collaborates with several highly visible programs on the Treasure Coast . 6. How will the program be accessible to target population (i. e. , location , transportation , hours of operation) ? Families are visited in their homes , with no required visits to the CASTLE administrative offices . To enroll in the program, all a parent must do is call the office . An intake screening is done over the phone. If the family seems appropriate for Safe Families, a home visit is scheduled within the next 48 hours . A more in-depth screening is done during the home visit to further ensure the appropriateness of Safe Families . Referrals from other service providers , churches or schools are accepted by fax or by mail . The same intake procedures follow the receipt of a faxed or mailed referral . The administrative offices are opened from 8 : OOam - 5 : OOpm . Home visits are scheduled weekdays , and weekday evenings , 7 Organization: Exchange Club CASTLE Program Name : Safe Families Funder: Children ' s Services Advisory Committee RFP #6067 D. MEASURABLE OUTCOMES - (Section D not to exceed two pages) OUTCOMES ACTIVITIES Add all o the elements or the Measurable Outcome(s) Add the tasks to accomplish the Outcome(s) 1 . Reduce the risk factors associated with child 1 . Provide information and education abuse for families in the Safe Families program regarding identified risk factors, during home by at least one, during enrollment in the visits, so that major risk factors are reduced or program and /or at the conclusion of the eliminated . program, for 90% of families who have been enrolled at least 3 months , as measured by a risk assessment tool (see appendix) . No more than 10% of families who have been enrolled for 3 months or more will show no (zero) risk factor reduction. 2002/2003 baseline : 100% of families reduced at least one risk factor. 2 . Maintain the reduction in risk factors (by at 2 . Complete the risk assessment tool one year least one) for a period of one year, for families after enrollment in Safe Families ends , with who have successfully completed the program, families who completed the program as measured by a risk assessment tool (see successfully. This will be done by phone appendix) in 90 % of families . No more than survey, with at least 20% of families who 10% of families who have successfully completed successfully , completed the program will fail to maintain a risk factor reduction. 2002/2003 baseline 97% of families maintained a risk factor reduction. 3 % failed to maintain a risk factor reduction. 3 . Increase the protective factors associated 3 . Provide information and education with a reduction in the risk of child abuse for regarding identified protective factors, during families in the Safe Families program by at home visits , so that major protective factors are least one, during enrollment in the program increased and/or improved upon. and /or at the conclusion of the program, for , 88% of families who have been enrolled for at least 3 months, as measured by a protective factor assessment tool (see appendix) . No more than 12% of families who have been enrolled for at least 3 months will fail to increase at least one protective factor. 2002/2003 baseline 98 % of families increased at least one protective factor. 2% of families failed to increase at least one protective factor. 8 . Organization: Exchange Club CASTLE Program Name : Safe Families Funder: Children ' s Services Advisory Committee RFP #6067 OUTCOMES ACTIVITIES Add all of the elements or your Measurable Outcome(s) Add the tasks to accomplish the Outcome(s) 4 . Maintain the increase in protective factors 4 . Complete the protective factor assessment (by at least one) for a period of one year, for tool one year after enrollment in Safe Families families who have successfully completed the ends , with families who completed the program, as measured by a protective factor program successfully. This will be done by assessment tool (see appendix) in 80% of phone survey, with at least 20% of families families . No more than 20% of families who who completed successfully, r have successfully completed the program will fail to maintain an increase in at least one protective factor. 2002/2003 baseline : 71 % of families maintained an increase in at least one protective factor. 29 % of families failed to maintain an increase in at least one protective factor. 5 . Maintain at 94 %, the number of families 5a. Provide information and education who complete the Safe Families program that regarding identified risk and protective factors , will have no confirmed reports or re-reports of during home visits , so that parents develop the abuse for up to one year after completing skills necessary to eliminate abuse/neglect as a services as measured by the state data base on risk in their home . abuse. No more than 6 % of the families who complete the Safe Families program will have 5b . The Department of Children and Families a confirmed report or re-report of abuse for up will compare the names of enrolled families to one year after completing services . against those reported for abuse/neglect to the 2002/2003 baseline : 98 % of families had no state abuse hotline, and provide the program reports or re-reports of abuse . 2% had a report with this information. or re-report of abuse . 6 . Maintain at 94% the number of families 6 . The AAPI test will be administered at the who , after successfully completing the Safe initiation of and at the conclusion of services . Families program, show improvement on the Scores will be compared to determine whether AAPI test, as measured by comparing their improvement has been made . pre-test score to their post-test score . No more than 6 % of families who, after successfully completing the program, will have no increase in a -post test score. 2002/2003 baseline : 98 % of families who successfully completed the program improved on their post test AAPI scores . 2 % did not improve . 9 Organization: Exchange Club CASTLE Program Name : Safe Families Funder: Children ' s Services Advisory Committee RFP #6067 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. Collaborative Agency Resources provided to the pTgram United For Families CASTLE staff to participate on leadership council ; CASTLE staff to remain on board of directors of UFF ; assist in planning and implementation of CBC contract ; jointly advocate for adequate funding. Children ' s Home Society Participate in weekly staffing meetings ; share relevant case information when necessary to assist families ; ensure that there is no dual enrollment through intake/assessment process and information sharing . Healthy Families Indian River CASTLE to continue operation of Healthy Families County Indian River County; share relevant case information when necessary to assist families ; ensure that there is no dual enrollment through intake/assessment process and information sharing; participate jointly in advocacy efforts to support child abuse prevention programs . Department of Children and . Participate in weekly staffing meetings ; share relevant Families case information when necessary to assist families ; ensure that there is no dual enrollment through intake/assessment process and information sharing. Treasure Coast Food Bank CASTLE will continue to host a food pantry for emergency food distribution. 10 Organization: Exchange Club CASTLE Program Name : Safe Families Funder: Children' s Services Advisory Committee RFP #6067 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 ? Age, gender, ethnicity, marital status , and address are collected upon intake . Eligibility for the program requires that children ages 0- 18 must be living in the home. Families must exhibit at least one risk factor on a child abuse risk factor checklist to be enrolled . Families who pose an imminent risk of harm to their children are referred to another program. Intake and eligibility information are assessed during an Initial Needs Assessment, which takes place during the first home visit. 2 . MEASURES : What data elements will you need to collect to show that you have achieved (or made progress toward) your Measurable Outcomes in Section D ? What tools or items are you using as measures (grades , survey scores , attendance, absences , skill levels) for your program? Are you getting baseline information from a source on your Collaboration List in Section E ? Are there results from your Activities in Section D that need to be documented ? How often do you need to collect or follow- up on this data? Outcome 1 (to reduce risk factors associated with abused is measured by a risk assessment tool that lists the risk factors identified at intake (see appendix) . Identified risk factors become the focus of intervention until they are resolved . Risk is assessed at least quarterly Outcome 2 (to maintain the reduction in risk factors) : is measured by a follow-up phone survey done one year after completion of the program, with families who complete the program successfully. Outcome 3 (to increase protective factors associated with a lower risk of child abuse) : is measured by a protective factor assessment tool that lists the protective factors identified at intake, and subsequently (see appendix) . Identified protective factors are a focus of intervention once risk factors have been reduced . Protective factors are assessed at least quarterly. Outcome 4 (to maintain the increase in protective factors, is measured by a follow-up phone survey done one year after completion of the program, with families who complete the program successfully. i Outcome 5 (no re-reports of abused is measured by the state database on abuse. Families enrolled in Safe Families for three months or more are checked to see if there have been any subsequent reports to the child abuse hotline. This check is done quarterly. Outcome 6 (improve on. post test scored is measured by the AAPI (Adult Adolescent Parenting Inventory), which is a nationally accepted standardized test that measures parent attitudes and beliefs . Low scores are associated with an increased risk of abuse ; high scores are associated with a lower risk of abuse . The test is administered during intake, and prior to closure. Other data collected include satisfaction surveys from all clients , and completion of family plan goals , for each family. 11 Organization: Exchange Club CASTLE Program Name : Safe Families Funder: Children ' s Services Advisory Committee RFP #6067 3 . REPORTING : What will you do with this information to show that change has occurred ? How will you use or present these results to the consumer, the funder, the program, and the community? How will you use this information to improve your program? Information collected is used to measure the progress of enrolled families , and to help determine the length and content of the intervention. Families are aware of their progress on the AAPI, risk/protective factor checklist, and family plan goals . Client satisfaction surveys are analyzed through the CASTLE ' s CQI process, in the Service Delivery committee. Recommendations for program improvements come from this committee . Results from collected information are reported to funders on a regular basis through monthly, quarterly or semi- annual reports . Staff, Board members, and other stakeholders are made aware of results through the CQI process , and feedback at all-team and Board meetings . The community is made aware of results through an annual report. 12 Organization: Exchange Club CASTLE Program Name : Safe Families • Funder: Children' s Services Advisory Committee RFP #6067 G. , TIMETABLE (Section G not to exceed one page) 1 . List the major action steps , activities, or cycles of events that will occur within the program year. New programs should include any start-up planning that may occur outside the funding year. In completing the timetable, review information detailed in prior sections . Month/Period Activities October 1 , 2004 Safe Families is a continuing program and will be fully staffed and in full operation at the start of the contract year. Regarding the program operation : 1 . Referred families are contacted within 48 hours . 2 . Referred families are assessed within 14 days . 3 . A family plan is developed within 30 days . 4 . Weekly visits take place for up to one year. 3 . Monthly and quarterly progress reports track client progress . 4 . Post testing and protective/risk factor assessments take place near the end of services . 5 . Follow-up is done within one year of closure . 13 Organization: Exchange Club CASTLE Program Name : Safe Families • Funder: Children ' s Services Advisory Committee RFP #6067 H. PROJECTIONS FOR UNDUPLICATED CLIENTS L Number of Unduplicated Clients by Location Current Fiscal Year = c� Location 0 OWN Budget 2003/04 0 /� Unduplicated Clients Unduplicated Clients Unduplicated Clients N. Indian River County 35 34 38 S . Indian River County 34 34 44 Indian River Co. Total 69 68 82 Greater Stuart 56 55 55 Hobe Sound 4 5 5 Indiantown 4 12 12 Jensen Beach 7 7 7 Palm City 11 11 11 Martin County Total 82 90 90 Fort Pierce 67 60 70 Port Saint Lucie 60 60 60 St. Lucie Co. Total 127 120 130 Other Locations 26 14 14 TOTAL SERVED 304 292 316 Unduplicated client = one enrolled family Number of Unduplicated Clients by Age ra Current Fiscal Year Location e 0® Budget 2003/04 _092"M >< s Individual Group do 0 to 4 - (Pre-school) 189 - 177 - 197 - 5 to 10 - (Elementary) 161 - 151 - 167 - I I 6711 to 14 - (Middle) 118 - 111 - 123 - 15 to 18 - (High School) 60 - 56 - 62 - Total Children 528 - 495 - 549 - 19 to 59 - (Adults) 358 - 337 - 373 - 60 + (Seniors) 56 - 53 - 58 - Total Adults 414 - 390 - 431 - TOTAL SERVED 942 - 885 - 980 - Individual numbers of children and adults represent the number of people in a family. A client (as listed in the top chart) equates to all the members of each family. The total served is the sum of all family members . 14 Organization: Exchange Club Castle Program: Safe Families 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 : Exchange Club CASTLE " Safe Families -Indian River County FUNDER : Children 's Services Advisory Committee 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 Abe used for calculations and to write information only. ANN w nab n (mss Wd ,R� V� l�rA§u!n61d,�k"4', :p'9eWcffl� ,Jegotalt �` C4 .t Butlge . _ Butl of 1 Children's Services Council-St. Lucie179, 114.49 2 Children's Services Council-Martin 137,673.41 3 Advisory Committee-Indian River " M 49 , 904 . 50 49 , 904. 50 65, 509 .50 4 United Way-St. Lucie County 57,280.09 5 United Way-Martin County ` <. ,�.� < : . 46, 588.29 6 United Way-Indian River County 939059.63 109,719. 63 7 United For Families 60.,257 . 19 397, 876 . 00 8 CountyFunds y, 0.00 9 Contributions-Cash 71000. 00 42 , 186.30 10 Program Fees 40,000. 00 11 Fund Raising Events -Net 180, 000 . 00 12 Sales to Public - Net 0.00 13 Membership Dues 14 Investment Incomes 51000 . 00 51000. 00 15 Miscellaneous 29000 .00 16 Legacies & Bequests . ' 0. 00 17 Funds from Other Sources _ 684,340 .45 18 Reserve Funds Used for Operating509000.00 19 In -Kind Donations (Not included in total) AWASW ml 51000. 00 20 TOTAL REVENUES (doesn't include line 19) $ 215 , 221 . 321 $49 , 904 . 501 $ 1 , 997,288 . 16 i t. . # Panama,w- , nm 1't-7' i� 21 Salaries - (must complete chart on next page) 101 ,822 .00 339983 . 00 988,024. 00 aIowa la f - 22 FICA Total salaries x 0. 0765 �Y 8 , 124 . 91 2 , 599.70 95,578 .00 Retirement - Annual pension or quai le 23 staff 41000. 00 2 ,439 . 00 42,000. 00 Life/Health - Medical/Dental/Short-term 24 Disab. � 100000.00 21200 .00 61 ,200 .00 Workers Compensation - # emp oyees x 25 rate 11062 . 80 560. 801 17,991 .00 on a Unemployment - # prolec e 26 employees x $7 , 000 x UCT-6 rate 0.00 0.00 511000.00 5/25/2004 15 Organization: Exchange Club Castle Program: Safe Families c p Gross ua �s 3 :..� ' P ";. tr Gros" nual bsi o it " a ^ "" V� ry (Agent ) � ary ed C!A n M '7&66060' ampa ct1 , New Counselor/20 hours 15,000. 00 15 ,000.00 109000 .00 66 . 67% A. Tovar- Dillahoy/Counselor/40 hours 33,503. 00 33 ,503 .00 111, 168.00 33 . 33% F . Sudbrock/Counselor/40 hours 28 ,960. 00 28 , 960.00 129815.00 44 . 25% New Supervisor/20 hours 28 , 080.00 14 ,040 .00 0.00 0 . 003/ Receptionsit/40 hours 20, 639 . 00 10 , 319. 00 0. 00 0 . 00% #DIV/0 ! #DIV/0 ! #DIV/0! #DIV/0! #DIV/0 ! #DIV/0 ! #DIV/01 #DIV/0 ! #DIV/0 ! #DIV/0 ! #DIV/0 ! #DIV/01 #DIV/0 ! #DIV/0 ! #DIV/0 ! #DIV/0 ! Remaining positions throughout the agency 8619842. 00 Total Salaries $ 988,024.00 $ 101 , 822 .00 $ 33 , 983 .00 3 .44% � ^ T �' , unaler'� � ecrf u�'gef trnc�e - � � �7a � OnerMil0v ne F ofalg nnges�F�under tOf lit /'Df7t4�Il Z' f0 ' � �$ get � � {A. � Ompers n .;Gom en pecffic l�5I O 7tlT 8/ a r OWNRI a anagen, 44 hrs S,QO .:DO �2 b 20°a Ua 3 ,�1, -v 50 . . ... . 500,0- .,.. . novo New Counselor/20 hours 100000.00 765 . 00 938 .00 845 . 52 214. 80 2 , 763 . 3 A. Tovar- Dillaho /Counselor/40 hours 119168 . 00 854 .35 699.00 630.26 161 .00 2 , 344. 61 F. Sudbrock/Counselor/40 hours 121,815.00 980. 35 802 . 00 724. 22 185.00 2 ,691 . 5 New Supervisor/20 hours 0.00 0. 00 0 . 0 Receptionsit/i hours 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 0.00 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 0.001 1 0. 0 Total Funder Request Fringe Benefits $33 ,983.00 $2 *599.701 $2 ,439 . 00 $2 , 200. 00 $560 .801 $ 0. 00 $79799. 5 5/25/2004 16 Organization: Exchange Club Castle Program: Safe Families . . - � gip` _ Y n gf ^ t"}t� -k "' i l (i E 1137 RE Y Prd�iisetl ofa Prograrri = � f Fundd ecrfic e vsedP4 to � � � n e p a yet Tofal genc ,, r ' Budgef� p Budy _z - ................ ,;:�.,✓• =•xmc - akt, ..- ";- ' d> " +o-."r� � :a �x_ _:.� � U�e���i , a 27 Travel-Daily 59954 . 52 0 . 00 40 ,000 . 00 # of Staff x average # of miles/wk x 50 Wks x ' Ge era =Mex'R'M"%��$ = Estimated Daily Travel/Mileage Reimb. t[eWIN 28 Travel/Conferences/Training 11359. 50 0.00 26 854 . 00 • National (cost per staff) • Training/Seminar (costperstaff) • Other Trainings (cost of travel, lodging , registration , food �p - _ i 9r ,. ., . , • -. e , Pfgfessron 29 Office Supplies PP � 4 ,220 . 95 500 . 00 22 ,000. 00 Office supplies (monthly average x 12 months = estimated cost of office supplies tt based on present history- _ ��erera-&Offie upplles & Gof5ler�,Papet 3 , b. k� ,,E ,,,... rte ag > � 30 Telephone 32495 .30 0 . 00 25,000 . 00 # Phone lines x average cost per month x 12 months = local phone cost ; Average long distance calls x 12 months �, 'i'e ephan s Celt P . ones,>k'ag r , � ' ^ � � � �• Estimated cost of long distance f x ;, . .. . . Nun efnet � z 31 Postage/Shipping , 2r243. 25 0.00 9,474 . 00 • Quarterly Mailirfg of Newsletter € 3 x, • Special events , etc. r General & i, ,, , znrogramGoertesponudrevneyNd 81'ce,X • Bulk mailings - appeals .a, Wax 32 Utilities 21340.48 _ • , �, 0.00 17, 060 . 00 • Electricity ($ x 12 months) wvrg • Water/Sewer ($ x 12 months) r ;: • Garbage $ x 12 months : 9 ( ) a tTras ..il, tectr ` �� 33 Occupancy (Building & Grounds) 4 . " °, 16 , 500 .00 71330 .00 90 , 344 . 00 • Mortgage/Rent ($ x 12 months) y • Janitorial ($ x 12 months) ='r 1 : ' l, • � e e ar aln en�nce ��, � x • Grounds Maint. ($ x 12 months) {f Gro , o nmg & R11111 It k - e airs ,. s v .. • Real Estate Taxes e 34 Printing & Publications r, 3 , 047 . 50 0 . 00 25 , 100. 00 Quarterly Newsletter ($ x 4) q ' r wxw • Letterheads , Envelopes, etc.• Fundraising materials• Other n 35 Subscription/Dues/Memberships a W 194 .63 0 . 00 31500. 00 • Membership to National Organization• Dues : . 1 • Subscriptions to Newspapers/magazines , ocal hambers Peven etc. „ tgw ,1z,. rgns, ,Newsp P..efis ,. . . . 36 Insurance - ' 2 ,070- 50 292 -00 13 , 050.00 • Directors/Officers Liab. r • Commercial/General Insurance • Bond Ins . ;' , I litI?8Q fl fes c a ` • Auto Insurance fi la6t, � _.;& Haza. . . lris r�llce r�-- . .. � . ."� . . . _,_ _ • ..., . . Y. .. � 37 Equipment: Rental & Maintenance 5,032 .08 0. 00 46 , 810. 00 • Copier lease ($ x 12 months) Y" • Meter lease ($ x 12 months) : • Copier Maintenance ($ x 12 months) ge , . 9ppl "t a nom_ • Computer Maintenance ( $ x 12 months) o etwor am ani sU "� � • Other 38 Advertising 1 , 140.65 0. 00 8 ,007 .00 • Newspaper ads • Fundraising ads/promotions • Other (vacancies) p 39 Equipment Purchases : Capital Expense 51038.00 0.00 0. 00 Computer/monitor (# x $) Laser Printer &2W2oo4 17 Organization: Exchange Club Castle Program: Safe Families 40 Professional Fees ( Legal, Consulting ) 0. 00 0 .00 0.00 Legal advice ( estimated #hrs x $) Consultant fees Other 41 Books/Educational Materials 11175. 00 0 .00 21 , 120 . 00 • Books/videos t " ook u " trona • Materials ($ x staff) 1 T ,..PP; pot , a& !. _e„ 42 Food & Nutrition - 0.00 0.00 0 . 00 • Meals ( # meals x clients x 5days x 50 wks) • Snacks 43 Administrative Costs 32 ,830.37 287 , 751 .00 - - • Admin. Cost (% of total budget) 44 Audit Expense 1 ,962 .89 0 .00 17 , 500 . 00 Independent Audit Review y{ ' k, • .,,,� dt .�. et!remgn' Programs . w �_;� . >' =; .. - h 45 Specific Assistance to Individuals 530.62 0-00 5 , 710 . 00 • Medical assistance . • Meals/Food ; • Rent Assistance • Other oaU - 04, rt�rvt. , u; - ecra 46 Other/Miscellaneous 1 ,075 .37 0.00 58 ,215 . 16 • Background check/drug test• F: µ Other a... Mrundt3U 47 Other/Contract 0.00 0 . 00 70 000. 00 Sub-contract forro ram services ' P 9 48 TOTAL EXPENSES �N $215, 221 . 32 $49,904. 50 $ 1 , 997,288 . 16 WS/200a 18 Organization: Exchange Qub Castle Program: Sale FamiAes UNIFORM GRANT APPLICATION TOTAL AGENCY BUDGET AGENCY/PROGRAM NAME : Exchange Club CASTLE-Safe Families -Indian River County FY 02/03 FY 03/04 FY 04/05 % INCREASE FYE Sept 2003 FYE Sept 30, 2004 FYE Sept 30, 2005 CURRENT VS. NEXT FY BUDGET A B C D ACTUAL TOTAL PROPOSED (col. C-col. BNCol. B REVENUES BUDGETED BUDGETED i Children's Services Council -St Lucie 162 ,202.00 1789100 .00 179 ,114.49 0. 57% 2 Children's Services Council-Martin 74,353 .00 136 ,696.00 1379673.41 0 .72% 3 Advisory Committee-Indian River 50 ,103 .00 50,000.00 65 ,509.50 31 .02% 4 United Way-St Lucie County 57 ,600 .00 557000.00 579280.09 4. 15% 5 United Way-Martin County 399140.00 36 ,002.00 465588. 29 29 .40 % 6 United Way-Indian River County 96 000.00 96 000.00 10%719.63 14.29% 7 Department of Children & Families 289Y792.00 354 021 .00 397 876 .00 12 . 39% 8 County Funds 0.00 0 .00 0.00 #DIV/01 9 Contributions-Cash 63 935.00 96 500.00 42186.30 -56 .28% io Program Fees 42 910.00 70 000.00 40 000.00 -42 . 86% 11 Fund Raising Events -Net 104 058.00 180 000.00 180 000. 00 0. 00% 12 Sales to Public-Net 0 .00 0 .00 0.00 #DIV/01 13 Membership Dues 0.00 0 .00 0.00 #DIV/01 14 Investment Income 12 988 . 00 79500.00 57000.00 -33. 33% 15 Miscellaneous 22900 .001 2 000 .00 2000 . 00 0 . 00 % 16 Legacies & Bequests 0 .00 0 .00 0 . 00 #DIV/01 17 Funds from Other Sources 447y815.00 628 462.00 684 340 .45 8 .89% 18 Reserve Funds Used for Operating 0 .00 75 000.00 50 000 . 00 -33 . 33% 19 In -Kind Donations (Not Included In tote) 79123.00 19 009 .00 0.00 -100.00 % 20 TOTAL 11450 , 919.00 1 965 281 .00 1 997 288.16 y 1{.63% �'-"E>... . � u.. .. ._ �X� . . -.;ti h~ .. .. .... S . a.._ �UBv�,. le.. .. s. .. y� .rv. . .::. FY,'� . . . �`, °Y'"_" .T✓.�`" �a ..j i+yi.4�.'�i✓"Y^' 4": EXPENDITURES 21 Salaries 717 692.00 110137073.00 988 024.00 -2 .47% 22 FICA 72 698 . 00 92 534.00 95P578 . 00 3 . 29% 23 Retirement 39g660. 00 40 000 . 00 42 000.00 5.00 % 24 Life/Health 58 295.00 61 200.00 61 200. 00 0 .00% 25 Workers Compensation 16 829 .00 17418 179991 .00 3 . 29 % 26 Florida Unemployment 71181 .00 8000 ,00 59000. 00 -37. 50% 27 TravelftDaily 45 856 .00 59 060.00 40 000 .00 -32 . 27% 28 Travel/Conferences/Training 43 371 .00 13 000 .00 26y854.00 106 . 57 % 29 Office Supplies 65 264.00 20 500.00 22 000.00 7.32% 30 Telephone 23 663 .00 29 196 .00 25 ,000. 00 -14. 37% 31 Postage/Shipping 71624.00 9 005.00 91474,00 5. 21 % 32 Utilities 12 427.00 15 024.00 17 060. 00 13 . 55% 33 Occupancy ( Building & Grounds 48y134.00 81 053.00 90 344. 00 11 .46 % 34 Printing & Publications 81622. 00 22 600.00 25 100.00 11 . 06% 35 Subscription/Dues/Memberships 3 007.00 49000 ,1 00 3 500.00 -12. 50% 36 Insurance 11 834.00 11 850.00 13 050.00 10. 13% 37 E ui ment: Rental & Maintenance 24 393 .00 36 160.00 46 ,810.00 29 .45% 38 Advertising 77186.00 7500 .00 81007.00 6 .76 % 39 Equipment Purchases :Ca ital Expense 27 308 .00 45 750.00 0.00 -100 .00 % 4o Professional Fees (Legal, Consulting ) 0 . 00 20 500 . 00 0.00 -100 .00% 41 Books/Educational Materials 71969.00 30 190.00 21 120.00 -30 .04% 42 Food & Nutrition 0. 00 0.00 0.00 #DIV/01 43 Administrative Costs 107y567,00 196528 287 751 .00 46 .42% 44FAuditEx ense 14 873 .00 20 000.00 17500.00 -12. 50% 45fic Assistance to Individuals 9 610 .00 7020.00 571000 -18 .66% 46Miscellaneous 6640.00 50 576.00 58 215.16 15. 10% 47Contract 63 216.00 53 544.00 70 000 .00 30.73% 48 TOTAL 19450 ,919.00 1965281 .00 1 ,997, 288,16 1 .63% 49 REVENUES OVER/ UNDER EXPENDITURES 0.001 0.00 0.00 #DIV/01 19 Organization: Exchange Club Castle Program: Sale Families UNIFORM GRANT APPLICATION TOTAL PROGRAM BUDGET AGENCY/PROGRAM NAME : Exchange Club CASTLE-Safe Families-Indian River County FY 02/03 FY 03104 FY 04/05 % INCREASE FYE Sept 30, 2003 FYE Sept 30, 2004 FYE Sept 30 , 2004 CURRENT VS. NEXT FY BUDGET A B C D ACTUAL TOTAL PROPOSED (col. Ccol. BNcol. B REVENUES I BUDGETED BUDGETED 1 Children's Services Council-St. Lucie #VALUEI 2 Children's Services Council -Martin 0.00 #DIV/01 3 Advisory Committee-Indian River 37 ,976.65 35,000 . 00 49 , 904. 50 42 . 58 % 4 United Way-St. Lucie County #VALUEI 5 United Way-Martin County0 . 00 #DIV/O ! 6 United Way-Indian River County 81 333. 38 80 000.00 93 , 059.63 16 . 32% 7 Department of Children & Families 67 238.00 67 238.00 60 , 257 . 19 -10 .38% 8 County Funds 0. 00 0.00 #DIV/01 9 Contributions-Cash 71000,00 7000 ,00 71000 . 00 0 .00% 10 Program Fees 0 . 00 #DIV/01 11 Fund Raising Events-Net 0.00 0 . 00 #DIVlO ! 12 Sales to Public-Net #VALUEI 13 Membership Dues 0.00 #VALUEI 14 Investment Income 2 000.00 495600 5 , 000 . 00 0 . 89% 15 Miscellaneous 0 . 00 #DIV/01 16 Legacies & Bequests 0 . 00 #DIV/01 17 Funds from Other Sources 0 . 00 #DIV/0 ! 18 Reserve Funds Used for Operating 0 . 00 #DIV/O ! 19 In-Kind Donations (Not included In total) 57000m # DIV/0 ! 20 TOTAL 195 548.03 194194.00 215 221 . 32 10 . 83 % EXPENDITURES 21 Salaries 115069. 84 101711 . 19 101 822 . 00 0 . 11 % 22 FICA 9292,75 7780,91 8 124 . 91 4 .42% 23 Retirement 12 789.51 39516 .43 41000 . 00 13 .75% 24 Life/Health 81549. 89 9828 .05 10 , 000 . 007 1 .75% 25 Workers Compensation 816.35 11666 .83 1 062 . 80 -36 . 24% 26 Florida Unemployment 0 . 00 #DIV/01 27 Travel-Daily 71309.06 4,423,46 51954 . 52 34 . 61 28 Travel/Conferences/Training 976.91 11952, 51 1 359. 50 -30 . 37% 29 Office Supplies 39597,71 41532. 30 4220 . 95 -6 . 87% 30 Telephone 3 058.87 31606 ,31 31495 .30 -3 .08% 31 Postage/Shipping 700.46 21293 . 22 21243 . 25 -2 . 18% 32 Utilities 400.75 19826.21 27340 .48 28 . 16% !33 Occupancy (Building & Grounds 14 031 .82 15 682,78 16 500. 00 5 . 21 % 34 Printing & Publications 41420, 37 714.75 3047 . 50 326 . 37% 35 Subscription/Dues/Memberships 44.53 134. 02 194. 63 45.22% 36 Insurance 19558 .54 29034.92 2 070 . 50 1 . 75% 37 Equipment: Rental & Maintenance 3t887.84 61194.31 5 032 .08 -18 .76% 38 Advertising 630.40 1 ,435.78 1 140 . 65 -20 . 56% 39 Equipment Purchases : Capital Expense 21503.98 6 064.76 57038 . 00 -16. 93% 40 Professional Fees (Legal , Consulting ) 0.00 357. 38 0.00 -100. 00% 41 Books/Educational Materials 79.06 212.27 17175 . 00 453 .54% 42 Food & Nutrition 0.00 0.00 0 .00 #DIV/0 ! 43 Administrative Costs 0.00 A51136.76 32 830.37 116 .89% 44 Audit Expense 893. 18 27155,38 1 962 . 89 -8. 93% 45 Specific Assistance to Individuals 8.37 845, 38 530.62 -37. 23% 46 Other/Miscellaneous 95.19 88.09 1 075.37 1120 .76% 47 Other/Contract 41834X5 0 .00 #DIV/01 48 TOTAL 195 548.03 194 194.00 215 221 . 32 10.83% 491 REVENUES OVER/ UNDER EXPENDITURES 0.00 0.00 0.001 #DIV/01 20 Organizabon: Exchange Club Castle Program: Safe Families UNIFORM GRANT APPLICATION Children ' s Advisory Committee SPECIFIC BUDGET PROGRAM EXPENSES AGENCYIPROGRAM NAME : Exchange Club CASTLE -Safe Families -Indian River County FUNDER : Children 's Advisory Committee A B C FY 04/05 FY 04/05 % OF TOTAL FUNDER TOTAL VS . PROGRAM SPECIFIC FUNDER REQUEST BUDGET BUDGET col. B/col . A) EXPENDITURES 21 Salaries 101 , 822 . 00 33 , 983 . 00 33 . 37 % 22 FICA 8 , 124 .91 2 , 599 .70 32 . 00 % 23 Retirement 4 , 000 . 00 21439 . 00 60 . 98 % 24 Life/Health 10 , 000 . 00 2 , 200 . 00 22 . 00 % 25 Workers Compensation 1 , 062 . 80 560 . 80 52 . 77 % 26 Florida Unemployment 0 .00 0 . 00 # DIV/0 ! 27 Travel -Daily 51954 . 52 0 . 00 0 . 00 % 28 Travel/Conferences/Training 11359 . 50 0 .00 0 . 00 % 29 Office Supplies 47220 . 95 500 . 00 11 . 85 % 30 Telephone 3 ,495 . 30 0 . 00 0 . 00 % 31 Postage/Shipping 2 , 243 . 25 0 . 00 0 . 00 % 32 Utilities 22340 .48 0 . 00 0 . 00 % 33 Occupancy (Building & Grounds 16 , 500 . 00 7 , 330 . 00 44 .42 % 34 Printing & Publications 39047 . 50 0 . 00 0 . 00% 35 Subscription/Dues/Memberships 194 . 63 0 . 00 0 . 00 % 36 Insurance 21070 . 50 292 . 00 14 . 10 % 37 Equipment: Rental & Maintenance 5 , 032 . 08 0 . 00 0 . 00 % 38 Advertising 11140 . 65 0 . 00 0 . 00 % 39 Equipment Purchases : Ca ital Expense 51038 . 00 0 . 00 0 . 00 % 40 Professional Fees ( Legal , Consulting ) 0 . 00 0 . 00 # DIV/0 ! 41 Books/Educational Materials 11175 . 00 0 . 00 0 . 00 % 42 Food & Nutrition 0 . 00 0 . 00 # DIV/01 43 Administrative Costs 32 , 830 . 37 0 . 00 0 .00 % 44 Audit Expense 11962 . 89 0 . 00 0 . 00 % 45 Specific Assistance to Individuals 530 . 62 0 . 00 0 .00% 46 Other/Miscellaneous 19075 . 37 0 . 00 0 .00% 47 Other/Contract 0 .00 0 , 001 # DIV/01 48 TOTAL $ 215 , 221 .32 $ 49 , 904 . 50 23 .19 % enarzoo4 21 Or an¢ab0n: Each g arge Cluh Castle Program Safe FartTas UNIFORM GRANT APPLICATION EXPLANATION FOR VARIANCES OF 15% OR MORE TOTAL PROGRAM BUDGET AGENCY/PROGRAM NAME : Exchange Club CASTLE FUNDER: Children 's Advisory Committee-Indian River County ._ }Ct'Ei4,N,4 C3N C3 tC , #VALUEI #DN/01 Advisory Committee-Indlan River #VALUEI #DN/01 United Way-Indian River County ;DIV/01 #DIV/01 #DIV/01 #VALUEI #VALUEI #DIV/01 #DIV/01 #DIVl01 #DIV/01 #DN/01 #DIV/01 Travel-DaltV Increase of travel to support families Utilities Increase of cost of utilities Printing & Publications Additional printing of newsletters Subscription/Dues/Memberships Incease of costs of subscriptions and memberships Books/Educational Materials Provide more material for the pro ram #DIV/01 Administrative Costs Reclasification of salaries to administative costs Other/Miscellaneous Increase of costs for background checks #DN/01 savzoa 22 Organkation: Exchange C4h Castle Program: Sate Families UNIFORM GRANT APPLICATION EXPLANATION FOR VARIANCES OF 15% OR MORE FUNDER SPECIFIC BUDGET AGENCY/PROGRAM NAME : FUNDER : Salaries New councilor to provide services FICA Increase associated with new councilor Retirement Increase associtated with new councilor Life/Health Increase associtated with new councilor Workers Compensation Increase associtated with new councilor #DIV/OI Occupancy (Building & Grounds Increase of rent #DIV/01 #D-IV/OI #DIVI01 srzsWa 23 EXHIBIT B [From policy adopted by Indian River County Board Of County Commissioners on February 19 , 2002] " D . Nonprofit Agency Responsibilities After Award of Funding Indian River County provides funding to all nonprofit agencies on a reimbursement basis only. All reimbursable expenses must be documented by an invoice and/or a copy of the canceled check . Any expense not documented properly to the satisfaction of the Office of Management & Budget and/or the County Administrator may not be reimbursed . If an agency repeatedly fails to provide adequate documentation , this may be reported to the Board of Commissioners . In the event an agency provides inadequate documentation on a consistent basis , funding may be discontinued immediately. Additionally, this may adversely affect future funding requests . Expenditures may only be reimbursed from the fiscal year for which funding was awarded . For example , no expenditures prior to October 1St may be reimbursed with funds from the following year. Additionally, if any funds are unexpended at the end of a fiscal year, these funds are not carried over to the next year unless expressly authorized by the Board of Commissioners . All requests for reimbursement at fiscal year end (September 30th) must be submitted on a timely basis . Each year, the Office of Management & 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 expenses by type . These summaries should be broken down into salaries , benefits , 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. " - 1 - 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: Joyce Johnston-Carlson , Director Indian River County Human Services 184025 th Street Vero Beach , Florida 32960-3365 Recipient : Exchange Club Castle P . O . Box 12908 Fort Pierce , Florida 34979 Attention : Theresa Garbarino-May, Executive Director 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 term and provision 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 the context indicates otherwise , words importing the singular number include the plural number, and vice 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. - 1 - Internal Revenue Service District Director Department of the Treasury Dater LG JAN 2 91982 Employer Identification Number 59 =2094472 • - Accourttling;Pertod: Ending: September - 30 Touridation Status Clat4ftatfon: o . v Scan America of the Treasure 509 ( a ) ( 1) & 170 (b ) (1 ) ( A ). ( -vi ) Coast , Inc . Advance Ruling Period EWS:' 241'4 Nebraska Avenue '"September 30; -: 1983 - Fort pierce , Florida 33450 Person to Contact: ' Y : ' Burleson/eb Contact Telephone Number. ( 904 ) 791-2636 . ::_ . . FFN : 58o014494 Dear Applicant : ' Based on information supplied , and assuming -your ' operations Will be as - stated in your application for recognitidn of exemption , we have determined you "'am - exenipt �` from Federal ibcome tax under section 501 ( c ) ( 3-) of the Internal Revenue Code:.-- Because you are a newlyg 7' t: mcrdated or anizat:ion we are now making $• final- determination of Your foundation status under section 509 ( a ) of the Code. : `Hovrever , . we have determined that you can reasonably be expected to be a publicly supported organization' described i_ n :section 170 (b) ( 1 ) ( A ) yi ) & 509 ( a) (-,j) , ' • ? ; : Accdrdingly , you will * be treated as a ubli'cl ksu - • • as ot a private foundation , � P Y . pported organization ; uand : •not during an advance ..-ruling mperiodA ••This = advance ruling . period begins on the date of your inception 'and ends ori the date shown- above . - : ,; .. , K ::. • . F Within 904*' days after the end ofyou''r advance - ruling period ; :YOU - "must •=submit to us information "needed to - determine whether you have met = I If your sources . of support , or so we . cahyour considerothe , effectcofrtherchanged change , please let us know on Yoperation ur exempt status and foundation status . Also , you should inform us of all changes in Your name or address . Generally , you -are. not , liable for social security a waiver of exengption . cerZificate as ( 'SCA ) taxes unless you file Act . If you have . paid FICA taxes withoutvfilingntheewaiveral ' Insurance Contributions are not liable . for the you should call us . You imposed under the Federal Unemployment Tax Act ( FUTA ) , Organizations "thatf are ,not taxes under Chapterprivate foundations are not . subject to the excise 4tax sthIfCodea However , you are not automatically exempt from Other Federal excise You have any questions about excise , employment , or other Federal taxes et please let us know . Aonors may deduct contributions to Bequests , legacies , ., devises , transfers , or gifts iftsas rtoldou or Portion 170 of the Code . deductible for Federal estate and gift tax u Y Your use are provisions of sections 2055 , 2106 , and 2522 of tihesCodeif hey meet the applicable . &You are . required to: file Form, 990 , . Return . of Organization Exemt from Income Tax , only if your gross receipts eacp h year are normally' than $10 , 000 . If return is required., zit must be filed by' the 15th day of the fifth month after the end xi your annual accounting period . The law imposes a a 'maximum of 5 penalty of $10 a day , up to $ , Q00 , when a return is filed late , unless there is reasonable cause for the delay . You are not required to file Federal income . tax returns unless " _ Iou to the . tax on unrelated business income under sectiono5il oP the Code , If are- sub3ect " subject to this tax , you must file an . income tax return on Form ,990-T . In this letter , we : are not determining ."whether any of -Your are unrelated trade . ;or business as ' defined in sectioneseno513tofrtheoCoded activities You need an employer identification number even if you have no employees . If employer identification number was o be assigned to . you andn t entered on your application , * a number will be . you will be advised of it . Please use that number on all returns. you file and in all correspondence with the Internal Revenue Service . ' Because this letter could help resolve an and -foundation statuse Y questions about your exempt status , you should k � p it in your. permanent . . records . If you have any questions , please contact the person whose name and telephone number are shown in the heading of this letter . Sincerely yours , ntst c Ulrecto CC ; Eugene J . O ` Neill , nccinnl f6 -77 ) Internal Revenue Service District Director Department of the Treasury MAR 0 11984 Person to contact : Ann Price./Ich- Telephone Number: ( 404 ) 221 - 4516 Exchange Club Center for the . Prevention of Child Abuse efr720lyto : cif the Treasure Coast , Inc . 2414 Nebraska Avenue 1 . AP Fort Pierce , FL 33450 Employee Identification 59 - 2094472 Number . File Folder Number : 580014494 Dear Sir or Madam : Date of Exemption: February 3 , 1981 Interna ( Revenue Code Section: 501 (c) (3) Gentlemen : Thank you for submittin it a part of your file , g the information shown below . We have made The changes indicated do not adversel and the exemption letter issued to cy affect YOUontinues inyeffect , status ThisPlease let us know about any future change in the char , ois � amrequiremenpethod of 0efation ,or iname or address Of organization . ng your exempt status � rganization . Thank you for your cooperation . Sincerely yours , Dist c Dtrecto Item ChangedFrom Name — To SCAN America of the Treasure Shown Above Coast Inc . 275 Peachtree Street, N . E. , Atlanta , GA 30043 . letter 976 ( Dc ) ( 7 -7711 NRY- 18-2004 13 : 58 HARBOR INSURANCE AGENCY 772 460 2315 P - 07/ 12 ACORDOP ID DATE (MMIDDIYYYI') � CERTIFICATE OF LIABILITY INSURANCE EXCHA- 1 05 / 18 / 04 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HARBOR INSURANCE AGENCY HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 222 Colonial Road , Suite 100 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Pierce FYI 34950 - 5309 •s __.jne : 772 - 461 - 6040 Fax : 772 - 460 - 2315 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: Philadelphia lndamnity Ins o The Exchange Club Center fo the Prevention of INSURER B: Hartford Ins Co of the Midwest Child Abuse DHA " Exchange club C . A • S . T . L . E . INSURER C: PO Box 12908 INSURER D: Ft Pierce F11 34979 INSURER F: COVERAGES THE. POLICES 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 CONTRACTOR OTHER DOCUMENT MTN RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INS -- ' CYEFFVCT CMPTRATiri LTR NSR TYPE OF INSURANCE POLICY NUMBER DATE MMIDD/Y DATE: MM/DU" LIMITS GENERAL LIABILITY EACH OCCURRENCE S 1 , 0001000 UAMACEI A X X COMMERCIAL GENERAL LIABILITY PHPK071434 03 / 26 / 04 03 / 26 / 05 PREMISES (Eaoccurenca) $ 1001000 CLAIMS MADE I XI OCCUR MED EXP (Any one person) $ 51F000 _ A , _ X Sexual /MOlestatio PERSONAL & ADV INJURY S 1 , 000 000 _ GENERAL AGGREGATE S Q 000 , 000 GEMLAGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOPAGG $ 2F000 POLICY jar LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (EaacGdeny S ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) 5 HIRED AUTOS BODILY INJURY NON-OWNEDAUTOS (Per accident) S PROPERTY DAMAGE S -- (Por acddu+q GARAGE. LIABILITY AUTO ONLY - EA ACCIDENT S ANYAUTO OTyERTKAN EA ACC $ AUTO ONLY: AGG b i EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ _ OCCUR CLAIMS MADE AGGREGATE 5 l S DEDUCTIBLE S RETENTION S S WORKERS COMPENSATION AND X ER EMPLOYERS' LIABILITY TORY LIMITS B I ANY PROPRIETOR/PARTNER/EXECUTIVE 21WBDU9 5 6 7 12 / 01 / 03 12 / 01 / 04 E,L , EACH ACCIMNT $ 5001 () 00 —` OfFICEfVMEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE S 5 OO O O O if ycs. dosrrme under SPECIAL PROVISIONS b01ow E.L. DISEASE - POLICY LIMB S so o 00 0 OTHER 1 A Professional Liab PHPK071434 03 / 26 / 04 03 / 26 / 05 Occurrenc $ 1 , 000 , 000 Aggregate $ 2000000 7ESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Company AT Employee Dishonesty , Policy #PHPK071434 , 03 / 26 / 04 - 03 / 26 / 05 , $ 100 , 000 Blanket Form A . Certificate holder is an additional inured for general liability with respects to Safe Families & Valued Visits Programs , * 10 days non - payment of premium . CERTIFICATE HOLDER CANCELLATION INDIA - 2 SHOULD ANY OF THE ABOVE DESCRIBED PDLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TD MAIL 30 * DAYS WRITTEN Indian River County NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO 50 SHALL Con184 0 i A 9th ers Street IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR 1840 25th Street Vero Beach FL 32960 REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ICindy McCall r / CORD 25 (2001108) © AC RD CORP RATION 1988 MRY- 18-2004 13 : 58 HARBOR INSURANCE AGENCY 772 460 2315 P . 07/ 12 OP ID DATE (MM/DI)NYYY) ACORD� CERTIFICATE OF LIABILITY INSURANCE EXCHA- 1 05 / 18 / 04 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HARBOR INSURANCE AGENCY HOLDER, THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 2122 Colonial Road , Suite 100 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, Fierce FTI 34950 - 5309 i _.�one : 772 - 461 - 6040 Fax : 772 - 460 - 2315 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: Philadelphia lndemnity Ina Co The Exchange Club Center -l•• fo the Prevention of INSURER Hartford Ina CO of the Midwest Ch ld Abuse DBA " Exchange Club C . A . S . T . L . E . INSURER C: PO Box 12908 INSURER D: Ft Pierce FL 34979 - INSURER E: COVERAGES THE POLOES 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL TUE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. �FMCYEFF15CT CYEXPIRA7I6 LTR N811TYPE OF INSURANCE POLICY NUMBER DATE (MMID DATE MM/DD/YY LIMITS GENERAL LIABILITY EACH OCCURRENCE S 1 , 000 , 000 DAMAGE 0R 0 A X X COMMERCIAL GENERAL LIABILITY FHPAO 714 3 4 03 / 26 / 04 03 / Z6 / 05 PREMISES (Ee occurenco) $ 100 , 00 CLAIMS MADE I X I OCCUR MED EXP (Arty one person) ' S 5 0 0 0 -- A X Sexual /MOlestatio PERSONAL & ADV INJURY S 1 , 00_0 000 _ GENERAL AGGREGATE_ S Q 0 0 0 , 0 0 0 GENE AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG S 2 , 00 0 1000 POLICY PRO• JLOC ECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S ANY AUTO (Ea seddent) ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) S HIRED AUTOS BODILY INJURY u r NON-OWNED AUTOS (Perecdoent) $ - - PROPERTY DAMAGE S -.r • -- (Por acddanq GARAGE LIABIUTY AUTO ONLY - EA ACCIDENT S ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG S i EXCESSNMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE 5 S DEDUCTIBLE S RETENTION S S WORKERS COMPENSATION AND TORY LIMITS X1 ER EMPLOYERS' LIABILITY B IANYPROPRIETOWPARTNERIEXEcurIVE 21WBDU9567 12 / 01 / 03 12 / 01/ 04 E.L. EACH ACCIDENT $ 500 , 000 —` OFFICERIMEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE S 500 O O 0 If ycs, dcscdbe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $ 500 000 OTHER ' ]AProfassional Liab PHPK071434 03 / 26 / 04 03 / 26 / 05 Occurrenc $ 1 , 000 , 000 Aggregate $ 2000 000 aESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS Company A : Employee Dishonesty , Policy ##PHPK071434 , 03 / 26 / 04 - 03 / 26 / 05 , $ 100 , 000 Blanket Form A . Certificate holder is an additional inured for general liability with respects to Safe Families & Valued Visits Programs . * 10 days non - payment of premium . CERTIFICATE HOLDER CANCELLATION INDIA - 2 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENOEAVORTD MAIL 301P DAYS WRITTEN Indian River County NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL 184 0 25th Street s a ionera 1840 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR Vero Beach Fla 32960 REPRESENTATIVES. - AUTHORIZED REPRESENTATIVE JCindy McCall r ' CORD 25 (2001108) ® AC RD CORPORATION 1988 i Child Abuse Services , Mraining & Life Enrichment October 20 , 2004 Joyce Johnston- Carlson, Director Indian giver County Human Services 184025 1h Street, Vero Beach, FL 32960 - 3365 Dear Joyce, Enclosed are the contracts for the 2004 - 2005 fiscal year for the Valued Visits and Safe Families programs . Also included are the requested insurance certifications , and 501 (c) 3 documentation . The CASTLE does not transport clients in Indian River County. Please let us know if there is anything further you need . Sincerely, There a Garbarino -May Executive Director EXCHANGE CLUB CASTLE Mailing Address : P. O. Box 12908 • Fort Pierce , Fl 34979 Office: 3525 SW Midway Road • Fort Pierce, FI_ 34981 Voice : 772 . 465 . 6011 • Fax: 772 . 465 . 6013 • Email : tgarbarino-may « exclzangecastle . org Sponsored in part by Exchange Clubs, the State of Florida, United for Families, United Way of Indian River, Martin, St. Lucie and Okeechobee Counties , Children's Services Councils of Martin and St. Lucie Counties and CSN of Indian River County. 11 :' 03 ' 2004 16 : 17 FAX 772 4656013 EXCHANGE CLUB CASTLE Z002 67 (POIICy Provisions: WC 00 00 00 A ) 95 tea INFORMATION PAGE wB WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY INSURER * HARTFORD INSURANCE COMP&MY OF THE MIDWEST HARTFORD PLAZA , W& TFOR D , CONNECTICUT 05115 NCCI Company Number: SA= RTFt.I R Company Code : G N sr O+ O 6urflu LARS RENEWAL © Previous Policy Number: �y� rule � r.7 u'rDi HOUSING CODE: : DH 1 . Named insured and Mailing Address: EXCHANGE CLUB CENTER FOR THE (Na. , Street, Town , State, ZIP Code) PREVENTION OF CHILD ABUSE DBA ( SEE & TDT ) PO BOX 12908 r4 FEIN Number. 592094472 FORT PIERCE , FL 34979 State Identltication Number(s): r Nami .� 'Che Named Insured le: CORPORATION Business of Flamed Insured: COUNSEL TO PREV1. NT CHILD ABUSE 01her workplaces not shown above: S4E ATTACHED SCHEDUL..SS 29 ProlicyPerlod: From 12 / 0 .9. / 03 TO 121' 01 / 04 12:01 a .m . , Standard time at the insureds mailing address. Producers Name: HARBOR INSURANCE AGENCY .w. 2222 COLONTAL ROAD , SUITE 100 FT PIERCE , FL 34950 Producer's Cade: 220020 SWENEW Issuing Office: TIDE HARTFORD 8711 UNIVERSITY EAST DRIVE mm CHARLOTTE NC 28213 Total Estimated Annual Premium : $ 10 , 377 - --- —� Deposit Premium : Policy Minimum Premium : $$ 334 FL ( INCLUDES INCREAS13D LIMIT MIN . PREM . ) Audit Period: ANNUAL Installment Tenn: The policy Is not binding unless countersigned by our authorized reprosentalive. Countersigned by � ,? , �. : `. • /, t , � // �C' /�' A.utharizeIre se alive Data l Form SWC 00 00 01 A (1 ) Printed in U .S.A. Page 1 (Continued on next page) Process Data: 09 / 1. 0 / 03 Policy 0Wirati*n Data: 12 / 01 / 04 ORIG2NAL 11 ,' 03 , 12004 16 : 17 FAX 772 4651013 EXCHANGE CLIfB CASTLE zoo , r INFORMATION PAGE (Continued) Policy Number: 21 WB DU9567 a. A, Workara Compensation Insurance: Part one of the policy applies to the Workers Compensation Law of the states listed here: FL ( SPO ) . E. Employers Liability Insurance: Part Two of the policy applies to work in each state listed in item 3.A. The lirnits of our Iiablli: under Part Two are: Bodily injury by Accident $ 500 , 000 each accident Bodily Injury by Disease $ 500F000 policy limit Bod fly Injury by Disease $ 500 , 000 each employee C, Other States Insurnrlce: Part Three of the policy applies to the states, if any , listed hare: CA ALL STATES M: EPT ND , OH , WA , WV, WY , AND STATES DESIGNATED IN ITEM 3 . A . OF THE INFORMATION PAGE . �+ 0 -+ D. This policy Includes these endorsements and schedule: WC 99 00 05 WC 00 04 06 WC 00 04 20 2G2240 21) WC 00 04 14 Ln WC 00 04 19 WC 09 06 06 WC 99 02 78 R4. The premilum for this policy will be determined by our Manuals of Ames, Clasalfi anions, Rats$ and Rating Pkm. All lirlormation required below is vubject to verification and clue b audit. -- -- _- Premium I3esla Classifications Total Estimated Elates Per Estimated Code Number and Annual $1d0 of Annual log (Description _ _ Remuneration Remuneration Premium - - ( SEE ATTACHED SCHEDU.JAES ) INCREASED LIMITS PAR': TWO ( 9 8 0 7 ) 080 PERCENT 79 TOTAL PREMIUM StTB EC". TO EXPERXENCE MODIFICATION 100001 —=®- FL -- INTRA FiPERIENCF:: MODIFICATION 091190907 1 , t' 10 PREMIUM ADJUSTED BY A.E"PLT_CATTON OF EXPERIENCE MODIFICATXON 10 , 111 ,r TOTAL ESTIMATED ANNUAL STANDARD PREMIUM 10 , 1Lt1 PREMIUM DISCOUNT 1 . 8 PERCENT -- 19 ENSE CONSTANT ( 0900 ) 20G, TERRORISM RISK INS AC"" OF 2002 ( 9740 ) 861 , 251 . 030 258 TOTAL ESTIMATED ANNUAL PREMIUM . 10 , 377 t� Total Estimated Annual Premium : $ 10j377 Deposit Premlum ; Policy) Minimum Premium : $ 334 FL ( INCLUDES INCREASED LIICT MIN . PREM . ) IrttsrstaWntrastate Identificsdlon Number: / 091190907 Labor Contractors Policy Number: Sic: (Form WC 00 00 01 A (t ) Printed in U.S.A . Page 2 ProoessDate; 09 / 10 / 03 Policy EVIratlonDate : ". 2 / 01 ; 4