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HomeMy WebLinkAbout2004-229A n 10 - iz • oy ORIGINAL Indian River County Grant Contract dy - ZZ 9 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 Community Child Care Resources, Inc . (CCCR) , ( Recipient) , of: Community Child Care Resources , Inc . (CCCR) 1801 24th Street Vero Beach , Florida 32960 Psychological Services 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 Seven Thousand Dollars ($7 , 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 , 20049 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: Caroline D . Ginn , Chairman ,r. BCC Approved : /a �/Z - 034' Attes . Barton , Clerk VP B .y ` Deputy Clerk � � x t { A 1 e Approved : Josep1h A . Baird County Administrator Ap{Sr ed as to form and legal sufficiency: ri E srs an n orney RECIPIE T: By: Community Child Care Resources 4 - EXHIBIT A [Copy of complete proposal/application] - 1 - Community Child Care Resources, Inc. Psychological Services Children's Services Advisory Committee PROGRAM COVER PAGE . . Or ganization .Name: Community Child Care Resources, Inc. A M 11 Executive Director: Abby Walters E-mail : cccrvero@aol . com Address : 1801 24`h Street Telephone : 567-3202 Vero Beach, Florida 32960 Fax : 567- 1136 Program Director: Same as above E-mail : Pro amlitte Ny' 66 hotogical Services Priority Need Area Addressed: MENTAL WELLNESS ISSUES : 1 . Increasing programs that promote emotional-social skills . 2 . Increasing early intervention services for "borderline" children — physical-emotional . Brief Description of the Program : This program provides parent counseling (RP450 . 650) and in- person crisis intervention (RP450 . 330) services to CCCR families and contracting centers. Families receive individual and/or family therapy from various contracting CCCR mental health professionals . Centers receive classroom support through site visits by therapists specializing in early childhood. children. SUMMARY REPORT - (Enter Information In The Black Cells Only) ` ' ntProgram ' Funding"" ( 2003 /04 ) : $ ° ~ ;ua'; 8250g4 G`u e Ya1v 41' tvu .. 4 •. .. DoY of ncrease /( decrease ) in request : $ n Percent increase / decrease in request * * 0 . 0 % Unduplicated Number of Children to be served Individually : 25 Unduplicated Number of Adults to be served Individually : - Unduplicated Number to be served via Group settings : 72 Total Program Cost per Client : 496 . 47 * *If request increased 5 % or more, briefly explain why: If these funds are being used to match another source, name the source and the $ amount : United Way, Success by Six : $4,000 . 00 , Organization 's Board of Directors has approved this application on date). May 4. 2004 l5 / o / oy Lisa Kahle/Ch it of thb Board delSignature Abby Walte xecut ' a Director/CEO Signatud Application for 2004.2005 service period 3 Community Child Care Resources, Inc. Psychological Services Children's Services Advisory Committee 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 %" X 11 " paper and number each page. A. ORGANIZATION CAPABILITY (Entire Section A not to exceed one page) 1 . Provide the mission statement and vision of your organization. Mission statement: CCCR will ensure the availability of high quality early childhood development and family support programs to lower-income, working families of Indian River County. The vision of CCCR is for childcare to be available and affordable for all children who qualify, and that the quality of childcare in Indian River County will be enhanced. In addition, parents will be able to work secure in the knowledge their children are thriving, and families will be strengthened and better able to nurture their children into responsible adulthood. CCCR envisions a community that embraces the mission and recognizes that community-wide support will improve the quality of life for all citizens . 2. Provide a brief summary of your organization including areas of expertise, accomplishments, and population served . CCCR contracts with six local childcare centers located on eight sites, to deliver quality childcare programs for children from birth to kindergarten. CCCR serves working families who meet income eligibility guidelines. Centers must meet CCCR standards of quality. A team of early childhood professionals are involved in the process of choosing and assessing centers. Once accepted as anew provider, a center has provisional status for a period of at least one year. Centers receive unannounced weekly monitoring visits. Staffs receive training and support, and center directors meet bi-monthly with CCCR staff to discuss issues that affect the delivery of a quality program. The criteria for contracting include : a program which is both age and individually appropriate; specifically trained and adequately compensated teachers; low adult to child ratios ( 1 : 10 for preschool) ( 1 : 8 for 2 yr. olds) ( 1 : 6 for toddlers) ( 1 :4 for infants); close ties with families and meaningful parental involvement; and access to comprehensive services. They are reimbursed at a rate to support the required standards. CCCR' s program places emphasis upon a strong family support and education component, including parenting workshops, parent/child interactive Saturday programs, parent support groups, mentoring, resource and referral, and professional psychological clinical support. Children' s progress is monitored and documented . There is parental choice among centers. Parents sign a contract committing to a sliding fee scale, and mandatory participations in orientations, parent/teacher conferences and parent education programs throughout the year. CCCR conducts fundraising and promotes public awareness, which are vital to the support, sustainability, and delivery of the program. Application for 2004-2005 service period 4 Community Child Care Resources, Inc. Psychological Services Children's Services Advisory Committee 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. a . A percentage of all families face problems and stresses and need professional psychological intervention. Recent research indicates that more children three and under suffer from emotional stress, like adults, "but they lack the coping mechanisms years of living bring" (Florida Association for Infant Mental Health, 2003 ) . CCCR' s targeted population is more economically needy, and families historically face life challenges to a greater degree than the general population. Consequently, they exhibit a greater need for psychological support. Indian River County lacks sufficient psychological services to serve low- income families with mental health needs. In addition, there are challenges in identifying families with such needs and encouraging them to take advantage of available resources. CCCR centers lack clinical staff and the financial resources to independently contract with mental health professionals . Problems in the classroom that cannot be handled within the capabilities of the staff often result in the expulsion of the child in crisis. Teacher requests for therapeutic intervention center on the number of children (total class, not just CCCR) exhibiting inappropriate anger towards both fellow students and teachers . CCCR staff has seen an increase in inappropriate anger in classrooms in recent years . On-site visits by therapists increase impact by helping the teacher develop a plan for work with the child who is angry and disruptive, restoring a productive environment and showing the other children in the class positive strategies for dealing with anger. b . The targeted population is CCCR families who demonstrate a need for psychological services in one or more of the following areas : . 1) Children who exhibit behavioral, developmental, and/or emotional difficulties that seriously impact their chances for school and life success . 2) Parents who deal with issues like : abuse, divorce, depression, anxiety, custody, substance abuse or significant health problems. 3) Parents with "special needs" children in the family who need support. 4) CCCR centers need the opportunity to receive on-site professional psychological/behavioral support. c. Those in need appear to be spread evenly throughout Indian River County. d . In the 2002-2003 funding year 26% of CCCR families received psychological services. eight visits were made to classrooms, and 54 individual sessions were held, representing 78 hours of therapist time. Mid-year 2003 -2004, 10% of CCCR families were referred for counseling and four classroom visits were made, representing 30 hours of therapist time. The Devereux Early Childhood Assessment Program (DECA) is a social-emotional screening instrument used in all CCCR Centers. In 2002-2003 29% of all CCCR children scored outside the normal range, while only 12% of the CCCR children who had been with the program at least a year scored outside the norm. 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. a. CCCR and the School Readiness Coalition are the only programs in the County that tie psychological services, including direct intervention to the funding of childcare. b. The School Readiness Coalition has $ 5 ,000 in enhancement money to be used exclusively for direct services to individual children in their program. This would provide 60 hours of therapy, for Coalition children, and is unable to include family support. Application for 2004-2005 service period 5 Community Child Care Resources, Inc. Psychological Services Children's Services Advisory Committee C. PROGRAM DESCRIPTION (Entire Section C. 1 — 6, not to exceed two pages) 1 . List Priority Needs area addressed. Mental Health Wellness 1 . Increasing programs that promote enhanced emotional-social skills. 2 . Increasing early intervention for borderline children- physical/emotional, 2. Briefly describe program activities including location of services. a. All referrals start with the CCCR Family Resource Coordinator (FRC), who conferences with the parent to assess the problem, along with the need for intervention. Already-employed strategies and resources will be reviewed and recorded b. Once need is established, the FRC secures authorization for the referral from the Executive Director (E.D.) c. Parents select a therapist from a list of appropriate CCCR providers, and give written consent for information sharing d. The E.D. contacts the selected provider about CCCR' s funding criteria and reporting requirements e. Families with medical insurance use those benefits first. Families pay the therapist a $ 5 .00 fee for each visit f. The FRC monitors the treatment plan through regular conferences with families, and consults with providers (as appropriate) e. The FRC facilitates recommended changes in the child ' s individual school program, and with the classroom teacher monitors progress f. Services are provided at the office of the selected therapist Psycholo 'cin al Support to Centers : a. Contracting CCCR therapist allots 2-3 hour time blocks to CCCR centers with documented need. Purpose : work with classroom teachers on behavioral issues that may be interfering with social and/or cognitive learning in the classroom b. A teacher completes the pre-observation form prior to therapist visit. The therapist records observations, conferences with teacher, gives written strategies and sets date for follow-up C. The FRC follows-up to help the classroom teacher implement and evaluate program changes 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. CCCR recognizes that research indicates parent support and education are vital to a child ' s successful preschool experience. A child' s development does not end when he leaves the classroom. The child that goes home to a dysfunctional family will not thrive. CCCR' s Psychological Support Services component is often the only source of professional intervention for families. Dollars are best spent on childcare, when the child is able to return home to a functional family, capable of positively reinforcing, nurturing and appreciating the child. 15 individuals in 14 families sought treatment last year. 82% showed improvement in their Global Assessment of Function Scores, compared to 77% the previous year. All but one family attending more than two sessions showed a 100% increase in scores. The Children' s Center in Titusville, Florida, the Space Coast Early Intervention Center, and the Walden Preschool in Maryland are three model early intervention childcare facilities. Although these centers provide programs for special needs children, they each also enroll a "typically developing" population of students. All three are recognized as models of excellence, and all three have a Strong mental health counseling component Application for 2004-2005 service period 6 Community Child Care Resources, Inc. Psychological Services Children's services Advisory Committee to their overall program. Two years ago, CCCR developed a component to the Psychological Support Program that provided every CCCR classroom the opportunity for site visits by contracting therapists . The therapist worked with the entire classroom, and did not counsel individual children. In an end-of--year survey, center directors indicated that the positive impact on classroom behavior was significant. They indicated that teachers were less frustrated and seemed more willing to try new strategies. The percent of children exhibiting behavioral concerns in the classroom dropped from 29% in Fall of 2001 to 12% in Fall of 2002, as evidenced by Devereux Early Childhood Assessment screenings. Although our results do not weigh all mitigating factors, classroom intervention hada positive impact. 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 W nformation in the Position Listing on the Budget Narrative Worksheet), Professional Staff: Executive Director: ( 1 ) On average 8 hours per week are devoted to program . Experience/expertise in : securing and distributing funding for the program, monitoring compliance regarding reporting and billing procedures, maintaining a "bank" of quality therapists to serve families at a reduced hourly billing rate. Family Resource Coordinator: ( 1 ) On average 10 hours per week are devoted to program . Experience/ Expertise in : assessing referrals, monitoring treatment plans, implementing program changes in the classroom serving as a liaison among parents, therapists, and centers. Support Staff: Secretarv/Bookkeeper: ( 1 ) On average 4 hours per week is devoted to the program. Experience/expertise in: processing invoices from providers, monitoring parent compliance regarding fee payments, checking family health insurance benefits . 5. How will the target population be made aware of the program ? CCCR families are made aware of the psychological support program during intake, at the CCCR orientation, and individually through the Family Resource Coordinator. In addition, Center Staffs are aware of the availability of the program, and refer families in need. One of the challenges of psychological support is encouraging referred families to participate. Due to challenges in the past year, CCCR will have therapists available at orientation to introduce them to parents, and they will talk to Center Directors to encourage staff to support referred families to participate. How will the program be accessible to target population (i.e., location, transportation, hours of operation)? Within the parameters of therapist specialty, there is parental choice. This enables a parent to choose a therapist convenient to home or work. Some contracting therapists have evening and weekend appointments available for CCCR families. Some contracting therapists are willing to hold individual therapy sessions at the child' s center. Parents unable to pay the $5 . 00 fee may have it waived through CCCR' s program committee. Application for 2004-2005 service period 7 Community Child Care Resources, Inc. Psychological Services Children's Services Advisory Committee 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) 1 . To increase the number of referred families in 1 . Therapists will be introduced to families active treatment by 5 % during the 2004-2005 during CCCR and Center orientations. school year, as measured by the number of CCCR service options will be described. completed Mental Health Provider Forms. 2 . Therapists will come to Center Directors Baseline : Family Resource Coordinator' s meeting to encourage their staff to talk to Psychological Referrals log. referred parents about the value of the services . 3 . Referrals start with the CCCR Family Resource Coordinator (FRC), who talks with the parent to assess the problem and need for intervention. 4. Once need is established, the FRC secures referral authorization from the Executive Director (E.D.) 5 . Parents select a therapist from a list of CCCR providers appropriate to address the problem, and give written consent for sharing of information. 6 . The E. D . communicates CCCR' s funding criteria and reporting requirements to the provider. 7 . Families with medical insurance will use those benefits first. Families pay a $5 . 00 out of pocket" charge directly to the therapist. If the family can ' t afford the co- pay, the FRC will refer the case to the Program Committee who may waive the fee. 8 . Families schedule an initial appointment with the therapist. 9. The FRC will remain in weekly contact with the parent to encourage the parent to call for an appointment. 2 . 85 % of individuals attending more than two 1 . The therapist designs a treatment plan, and therapy sessions will raise their Global Assessment the family takes responsibility for the of Functioning (GAF) within the 2004-2005 school scheduling of all appointments, year, as measured by the Discharge GAF score. 2 . The FRC monitors the treatment plan Baseline : Admission GAF score, through regular conferences with the family, and consults informally with therapists as Application for 2004-2005 service period 8 Community Child Care Resources, Inc. Psychological Services Children's Services Advisory Committee appropriate. 3 . The FRC facilitates any recommended changes in the child' s. individual school program, and, with the classroom teacher monitors progress. 3 . To increase school readiness through a 10% 1 . Classroom teacher completes a request for increase in appropriate behavior in classrooms psychological services (Observation report), receiving intervention as measured by initial and documents specific inappropriate behaviors classroom teacher report and therapist observation requiring intervention. report. 2 . The contracting CCCR therapist schedules two-hour time blocks. Baseline : Classroom observation report for 3 . During the first visit, the Psychological psychological services and Therapist Classroom Services Classroom Report is completed. Services Report. 4 . The therapist works with the teacher to enhance the classroom environment, and supports the teacher with behavioral concerns . 6 .The therapist helps the teacher develop a behavior management plan, and conferences with the Center Director regarding implementation of the plan. 7. The CCCR Family Resource Coordinator (FRC) follows-up on a regular basis with the classroom teacher to help implement, adjust and evaluate the plan. 8 . If needed, the therapist makes additional visits and/or suggestions for individual child referrals. Application for 2004-2005 service period 9 , Community Child Care Resources, Inc. Psychological Services Children's Services Advisory Committee E. COLLABORATION (Entire Section E not to exceed one page) 1 . List your program ' s collaborative partners and the resources that they are providing to the program beyond referrals and support. (See individual funder requirements for inclusion of collaborative agreement tetters. Collaborative Agency Resources provided to the program CCCR Contracting Therapists : All CCCR therapists discount their hourly rate approximately 29%. Some provide evening and Linda Asher, Ph.D. weekend hours. Some provide service at the child' s Madeleine Laplante, M.A. , LMHC center. All complete the appropriate Mental Health Marcy Purdy, A. T.R.-B . C . Provider Forms or Psychological Support Classroom Charlotte Kay, M. S . , L.M.H. C . Report Forms, Community Church Partner' s The Partner' s program can transport CCCR families that Program they are working with to and from therapy appointments. The mentor will go with the parent to an initial appointment, if so desired. The Partner' s Program will pay for any medication that may be prescribed, if the parent cannot afford it. In addition, they will provide babysitting so a parent may go to a therapy ap intment. Indian River Public Schools Conduct diagnostic screening on CCCR children who and have learning and behavioral concerns. The data is then Florida Diagnostic & Learning used by the CCCR therapist to design a treatment plan. Resources System FDLRS) Indian River School Readiness CCCR manages psychological enhancement dollars for Coalition the School Readiness Coalition. CCCR coordinates referrals and therapist placements. The CCCR Mental Health provider Form, the Initial Classroom Observation Report, and the Psychological Services Survey are used by the Coalition. The collaboration provides direct psychological services for subsidized families and increased revenue for CCCR therapists willing to reduce rates for both programs. Application for 2004-2005 service period 10 Community Child Care Resources, Inc. Psychological Services Children's Services Advisory Committee a. PROGRAM EVALUATION (Entire Section F not to exceed two pages) 2 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 ? Data Elements Describing "Services to Families " Target Population: a. Source of referral — (center, parent, CCCR, outside agency) b. Form of treatment plan — (child, parent, couple, family) c. Diagnostic code (DX) number d. Admission Global Assessment of Functioning (GAF) number e. Anticipated number of service units that will be needed Data Elements Describing "Services to Classrooms " target Population - a. Number of children exhibiting behavioral concerns b. Number of children scoring below standard norms on DECA assessment C, Type and number of unsuccessful teacher interventions prior to requesting services d. Type and number of teacher requests for service in individual centers e. Number of service units used per classroom f. Number of children referred for individual therapy 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 ? Services to Families " Measurement Elements a. The number of referrals made for psychological services will be collected by the Family Resource Coordinator (FRC) and compiled in the Psychological Services Log. b . Mental Health Provider Forms completed by the therapist will be collected quarterly and compiled in the Psychological Services Log. The form documents admission and discharge GAF ' s, Diagnosis Codes and descriptions, # of appointments made, kept, cancelled and "no Show", anticipated length of treatment, and other outside resources being used. Services to Classrooms " Measurement Elements a. Fall and spring DECA assessment scores will be collected. in November and May and compiled in the Psychological Services Log. b . The numbers and types of classroom concerns are collected through the completion of the Teacher Observation Forms. They are submitted along with the Psychological Support Classroom Report Form to the FRC who compiles them in the psychological Services log. c. The Psychological Support Classroom Report form is completed by the therapist and submitted to the FRC (compiled in Psychological Services Log) . This form documents type and severity of behavioral concerns observed, description of strategies to be implemented, and the expected need for follow-up by the therapist to the classroom. Application for 2004-2005 service period 11 Community Child Care Resources, Inc. Psychological Services Children 's Services Advisory Committee 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? Services to Families- Reporting Change a. The number of referrals for service will be compared with the number of Mental Health Provider Forms completed. This will document the percent of families following through on referral . b. Data collected from the Mental Health Provider Form is used to compare the patient' s level of functioning before and after treatment. This will document the percent of patients who raised their GAF scores . Services to Classrooms- Reporting Change a. The Teacher Pre-Observation Form serves as a baseline in determining change. b. The Psychological Services Classroom Report Form documents areas to be addressed and strategies to be implemented. Sharing Results With the Consumer: Historical data about the percentage of CCCR families using psychological services are used as a "marketing tool" to help current CCCR families become comfortable asking for help. Therapists will be involved in future family orientations to describe the type of help they can offer through CCCR. Individually, therapists can help parents and children see what they have accomplished. DECA results are interpreted for parents during conferences to better describe how the child functions in a group, and the child' s status with social/emotional development With the Funder: Results are used to show progress and measure success. Generally presented in chart form, they document that the program delivers the services for which it is being funded. With the Program : Results are used by Board and staff to validate that the mission is being carried forward. Evaluative information helps target areas for improvement and growth. With the Community: Sharing measurable results about your program leads to community awareness that in turn may lead to new sources of funding. Outcome success also results in attracting quality people to your organization. Application for 2004-2005 service period 12 Community Child Care Resources, Inc. Psychological Services Children's Services Advisory Committee 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 Psycholo icg al Support to Children and Families 1 . Ongoing 1 . Referral and authorization process 2 . Ongoing 2 . Treatment 3 . Ongoing 3 . Family Resource Coordinator monitors treatment plan with therapist and shares as appropriate with Center. 4. December and April 4 , Mental Health Provider Forms completed by therapists. 5 . January and May 5 . Mental Health Provider Forms reviewed by Program Committee 6. At discharge 6 . Client satisfaction survey completed by parent Psychological Support to Centers 1 . Ongoing 1 . Documentation of need for clinical classroom support 2. Prior to Visit by therapist 2 . Teacher completes classroom report prior to observation for psychological services provider 3 . Day of Visit 3 . Therapist completes Psychological Services Classroom Report 4. Day of Visit 4 . Behavior Management Plan put in place 5 . Ongoing 5 . Family Resource Coordinator conducts classroom follow-up. 6. December and May 6 . Psychological Services Classroom Report reviewed by Program Committee Application for 2004-2005 service period 13 Community Child Care Resources, Inc. Psychological Services Children's Services Advisory Committee H. PROJECTIONS FOR UNDUPLICATED CLIENTS Number of Undu licated Clients by Location Last Fiseal- Year Current Fiscal Year Neat`Fiscal Year ' Location A004 : 2IW2C M Budget 2003/04 Projections 2004/05 Unduplicated Clients Unduplicated Clients Unduplicated Clients N. Indian River County 47 48 48 S. Indian River Coun 48 49 49 Indian River Co. Total 95 97 97 Greater Stuart Hobe Sound Indiantovm Jensen Beach Palm City Martin County Total Fort Pierce Port Saint Lucie St. Lucie Co. Total Other Locations TOTAL SERVED 95 97 97 Number of Unduplicated Clients by Age Last Fiscal Year Current Fiscal Year Next Fiscal Year Location Actual 2002/2003 Budget 2003/04 Projections 2004/05 Individ Group Individuals Group IndividualsGroup 0 to 4 - -school 15 80 22 75 22 75 5 to 10 - (Elementary) 11 to 14 - (Middle) - - - - _ 15 to 18 - Vfigh School Total Children 15 80 22 75 22 75 19 to 59 - Adults 60 + Seniors Total Adults TOTAL SERVED 151 801 22 751 22 75 Application for 2004-2005 service period 14 Community Child Care Resources, Inc. Psychological Services Children's Services Advisory Committee I. BUDGET FORMS - To open the Budget Forms, please double-click on the icon below. " Core Budget Forms " 15 Community Child Care Resources, Inc. Psychological services Children's Services Advisory Committee 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 Speck Budget Forms. AGENCYIPROGRAM NAME : FUNDER : r - . . - - - - - - - - • - - - - - - - - - - - - - - - - - - - - - - - - - - • - - - - - • - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - • - - - - . . _ . . - - - - - - - � CAUTION : Do not enter any figures where a cell is colored in dark blue - Formulas and/or links are in place. Gray areas should be used for calculations and to write information only. I ,m _ . . 4,g .3 '-rsm.,acz ' Y� rlt: `i tilt -. bRAY /1NE/3I'OR _ x R ..,Or REVEProposed oTotagencyUI, i , -a, B ``d < cateawtwNsi. " s Bud9@f >. . . tit:: �! . Badger 1 Children's Services Council-St Lucie 2 Children's Services Council-Martin 3 Advisory Committee4ndian River 8,500.00 8t500.00 228,500.00 4 United Wa -St Lucie County 5 United Way-Martin County 6 United Way-Indian River County4,000.00 183 ,954.00 7 Department of Children & Families 8 County Funds C, , 9 Contributions-Cash ChuHid s ', Org 190428 .00 103,200.00 It 10 Program Fees Parent fee' 41606.00 65,804.00 11 Fund Raising Events-Net 77 , I I 11 ,424.00 25,000.00 12 Sales to Public - Net 13 Membership Dues 14 Investment Income 200.00 800.00 15 Miscellaneous 16 Legacies S uests 17 Funds from Other Sources AIPI 80100.0 18 Reserve Funds Used for Operating 5hajara' Found 59000, 19 In-Kind Donations (Not Included in total 20 TOTAL REVENUES (doesn't include line 19) $48, 158.00 $8,500. 001 $620,358. 00 ILI It yak R " -g Yu ` f)x r z a r A ' ` { ' ,.+ a� fx r b %+ s - Y S ` ` ` x EI11hITURE +� wR Proposed Total Program y Funder S " ecrfic �� ryryry, P dotal Agency , /10E71GY UBE--ONLY :{ s it , . •` s ;a7.. :. "< s„ e `�- ;' +4 , r ."r {sNoNrCAt.Ctk.JR10N3 ' ' ` s , /7 ' ' • Bud et 21 Salaries - (must complete chart on next page) 23,828,00 0.00 1039312.7 ,y firjy , SS� ` qX-tIM'4 S�< UD `� ,i YtiwGT;. 'ykh' yt , .fi,..` "As .. yY - A* 3 •.' c z . . 22 FICA - Total salaries x 0.07657:6 19823.00 0.00 8t248.00 e remen - Annual pension Tor qua 23 staff ' 0 .00 Lffe/Heafth - e ice en 0 - erm < a 24 Disab. Is 0 . 00 Workers Compensation - # employees x 25 rate >t9 1 224.00 0. 00 971 .00 Honda Unemployment - # projectea 26 employees x $7,000 x UCT-6 rate 0.00 9 Ilk I. R'p vas-p.:n^ 1 Yt C31 p1919 11 1 S p. . ? vp' 'eh<'..':S„• ? { .i m J'�,' w . ' .' h�;: fi'xah�F .,e kx �?E< K. 4 a3` ..moi ° �` 3tui `wr S�AFill~S i t p o � 4x � K;NN S'av � i3 ha`>r , "S” s. V y�..3b�'3lyt-T.�4 `A y�4'FY' , � ��+"�,'tia; n-° iS"�"''• � > ` "s`f"a �" .V� V3i /'MHIW9 '�"> �` ' � �35r,- � M1 '? Y . 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O .� IL0 N 2ocn 9 � a m ¢ CT0206O oZLL o' U � P � c) Q 2 a w CL a N N M M cn M M " M M M '�Q' `? V O � O O a0 ch Nellr Ki Oi r r ell 41� to I ItE ell 11 lee I lee ell el ell eI V11. 12 ce le l le el 0 Q o (r$ Mv . O r 7 ii Y% r3q Pff S> w O kYRd e'r- ZVk ' lee 1, lY 1„ i (- r W d IVJ. M7 )ll eelp. IS Z � t ` 14 _ IV ell 1ellti l u \ 1Vt Slee t t I dy rz > Oy M .4U. 1. Vi'.5' J •. \ ie.�h `fit st. I le xt. d zp xr { ✓r le Pe r IV lee ell \ J 1 11 t ( V C V� W 2 a. !S o •° 2 u� ew m K `$ v e Q H o H ME ) Q °¢ Qso N2gcc0 om stn �' Co mxnky Chad Caro Resarem Int. Pr/&4w" Sxriee! ClNldron's Senrkes Advisory CommMtes UNIFORM GRANT APPLICATION TOTAL AGENCY BUDGET AGENCYIPROGRAM NAME: FY 02W FY 03104 FY 04W % INCREASE M M FYE CURRENT VS. July 1 • June 30 July 1 - June 30 July 1 - Juno 30 NEXT FY BUDGET A B C D ACTUAL TOTAL PROPOSED (tol. Cta sycol. e REVENUES BUDGETED BUDGETED 1 Children's Services Council-St Lucie 0.00 #DIV/01 Children's Services Council-Martin 0.00 #DIV/01 3 Advisory Committee-Indian River 167 000.00 M 188 500,00 228 500.00 21 .22% United Way-St Lucie County 0.00 #DIV/01 a United Way-Martin County 0.00 #DIV/0 ! s United Way- Indian River 180 328.72 183f964.00 183;954.00 0.00% rtment of Children $ Families 0.00 #DIV/01 a County Funds 0.00 #DIV/01 9 Contributlona Cash101 331 ,00 100 000.00 103 200.00 3. 20% 10 Program Fees 66 333,22 64 969,00 65 804.00 1 .29% 11 Fund Raisina Events-Net 14 261 .00 15o000.00 25 000.00 66.67% 12 Sales to Public-Net 0.00 #DIV/01 13 Membership Dues 0.00 #DIV/0! 14 Investment Income 21196,831 1 501 .00 800 .00 -46.70% 16 Miscellaneous 0 .00 #DIV/01 16 acles $ Bequests 0.00 #DIV/01 17 Funds from Other Sources ALPI 55 375.12 14 302.00 8100.00 43.36% 18 Reserve Funds Used for Operating 2000000 10 000,00 51000.00 -50.00% ig In-Kind Donations (" kwhided in ronq 0.00 #DIV/O ! 20 TOTAL 606 825.89 578 226.00 620 358 . 00 7.297 EXPENDITURES 21 Salaries 103 276.00 96 225.00 103 312.76 7.37% 22 FICA 8g328,001 79635.001 81248, 001 8.03% 23 Retirement 0.00 #DIV/O! 24 ! Lffe/Heatth 0.00 #DIV/0 ! 25 Workers Compensation 891 .00 894,00 971 .00 8. 61 % 26 Florida Unem to ment 0 .00 #DIV/01 27 Travel-Daily 673.00 p11710.001 19520.001 11 . 11 % 28 Travel/Conferences/Training 1j017.00 900.00 17000.00 11 . 11 % 29 Office Supplies 31560.75 3 750.00 3, 750.00 0.00% 30 Telephone 3 940.00 4,000.00 , 31000.00 -25.00% 31 Postage/Shipping 21520.111 2 500.00 27690.00 7.6000 32 Utilities 4 849.00 4 900,00 7f000.00 42.86% 33 Occupancy (Building $ Grounds 12 573,98 1592700 13 953.00 -12.39% 34 Printing $ Publication 11820,001 6 000.00 6X0.00 0.00% 35 Subscri on/Dues/Membemhi 1607.93 1000.00 750.00 -25.00% 36 Insurance Z450.001 41000.00 4%000.00 0.00% 37 E ui ment:Rental $ Maintenance 1 244,00 1 300.00 750.00 -42.31 % 38 Advertising 21380.001 600. 00 -74.79% 39 Equipment Purchases:Ca ital Expense 1 500.00 500.00 -66.67% 40 Professional Fees (Legal, Consuhin 01270.00 15 500.00 15 500.00 0.00% 41 Books/Educational Materials 2 000.00 37000.00 31050.00 1 .67% 42 Food $ Nutrition 1413.00 1200,00 900.00 25.00% 43 Administrative Costs 41538.591 39575,00 4V500.00 25.87% 44 Audit Expense 6165.00 69400,001 61500. 00 1 .561 45 Specific Assistance to Individuals 21000,00 2 000.00 27000.00 0.00% 46 Other/Miscell neons 10 000.00 51000.00 -50.00% 47 Other/Contract 394 593,53 371 930.00 419 842.00 12.88% 48 TOTAL 567 730.89 568 226.00 615 336.76 8. 29% 491 REVENUES OVER/ UNDER EXPENDITURES 39 095.00 10,000.00 51021 . 24 -49.79% errna w 20 • Cwfmoigy cnnd Cale Resouiees. Mo. Psydwlogical servkes ChBdren's services Advisory Coanrdltee UNIFORM GRANT APPLICATION TOTAL PROGRAM BUDGET AGENCYIPROGRAM NAME: FY 02/03 FY 03/04 FY 04/05 % INCREASE FYE ' FYE FYE CURRENT VS, Ju I-Am 30 Juij 1June 30 Ju 1-June 30 NEXT FY BUDGET A B C D ACTUAL TOTAL PROPOSED (cob Ctol. B) coi. B REVENUES BUDGETED BUDGETED 1 Children's Services Council-St Lucie 0.00 #DIV/01 2 Children's Services CounclWartin 0.00 #DIV/01 3 Advisory Committee-Indian River 71000.00 8500.00 81500.00 0. 00% United Way-St Lucie County 0.00 #DIV/01 b United Way-Martin County 0.00 #DIV/01 6 United W - Indian River County 4t969.071 49000-00 42060.00 0.00°% 7 Department of Children & Families 0.00 #DIV/01 8 County Funds 0.00 #DIV/01 9 Contributions-Cash 219200.091 20 150.00 19 428 .00 -3. 58% 10 Program Fees 4,700.00 45622.00 41606.00 -0.35% 11 Fund Raising Events-Net 10 000.00 10 500.00 11 424.00 8 .80% 12 Sales to Public-Net 0 .00 #DIV/0! 13 Membership Dues 0.00 #DIV/01 14 Investment Income 500.00 400.00 200.00 -50 .00% 15 Miscellaneous 0.00 #DIV/01 18 Legacies 8 Bequests 0.00 #DIV/01 17 Funds from Other Sources 0.00 #DIV/01 19 Reserve Funds Used for Operating 0.00 #DIV/0! is In-Kind Donations (NotMcla intaa0 0.00 #DIV/01 20 TOTAL 48 369.07 48f172.03 48 158.00 -0.03% EXPENDITURES 21 Salaries 26 374.00 24 980.00 23 828.00 -4.61 % 22 FICA 11989,001 19910.001 1 )823.001 -4.55% 23 Retirement 0.00 #DIV/01 24 Llfe/Health 0.00 #DIV/01 25 Workers Compensation 190.00 210.00 224.00 6. 67% 26 Florida Unemployment 0.00 #DIV/O! 27 Travel-Daily 10.00 25.00 18 .00 -28 .00% 28 Travel/Conferences/Training 0.00 #VALUE! 29 Office Supplies 11400.00 1 305.00 11388.00 6. 36% 3o Telephone 1j450.00 12320,00 11050.00 -20.45% 31 Postage/Shipping 510.00 575.00 619.00 7.65% 32 Utilities 1400.00 1470.00 2100.00 42. 86% 33 Occupancy (Building & Grounds 21277,001 2577.00 39209.001 24. 52% 34 Printing & Publications 800.00 1 300.00 19399.001 7.62% 35 Subscription/Dues/Memberships 0.00 #DIV/01 36 Insurance 0.00 #DIV/01 37 E u( ment:Rental & Maintenance 0.00 #DIV/01 38 Advertising 0.00 #DIV/O! 39 Equipment Purchases:Ca ital Expense 0.00 #DIV/01 40 Professional Fees (Legal, Consulting) 11 ,969.071 12 500.00 12 500.00 0.00% 41 Books/Educatlonal Materials 0.00 #DIV/01 42 Food & Nutrition 0.00 #DIV/01 43 Administrative Costs 0.00 #DIV/01 44 Audit Expense 0.00 #DIV/01 45 Specific Assistance to Individuals 0.00 #DIV/01 4s Other/Miscellaneous 0.00 #DIV/01 47 Other/Contract 0.00 #DIV/0! 48 TOTAL 48 369.07 48 172.00 48 158.00 -0.03% 49 REVENUES OVER/ UNDER EXPENDITURES 0.00 0.00 0.00 #DIV/01 MAN w 21 Community Child Care Resources, Inc. Psychological Services Children's Services Advisory Committee UNIFORM GRANT APPLICATION FUNDER SPECIFIC BUDGET PROGRAM EXPENSES AGENCY/PROGRAM NAME : FUNDER: A B C FY 04105 FY 04/05 % OF TOTAL FUNDER TOTAL VS. PROGRAM SPECIFIC FUNDER REQUEST BUDGET BUDGET col. B/col. A EXPENDITURES 21 Salaries 237828 .00 0 . 00 0 . 00 % 22 FICA 13823 . 00 0 .00 0 . 00% 23 Retirement 0 .00 0 . 00 #DIV/0 ! 24 Life/Health 0 . 00 0 . 00 # DIV/01 25 Workers Compensation 224.00 0 . 00 0 . 00% 26 Florida Unemployment 0 . 00 0 . 00 #DIV/0 ! 27 TraveWally 18 .00 0 .00 0 . 00% 28 Travel/Conferencesrrrainin 0 . 00 0 . 00 #DIV/0 ! 29 Office Supplies 11388 .00 0 .00 0 . 00% 30 Telephone 17050 . 00 0 . 00 0 . 00 % 31 Postage/Shipping 619 . 00 0 .00 0 . 00% 32 Utilities 2 , 100 . 00 0 . 00 0 . 00 % 33 Occupancy (Building & Grounds 39209 . 00 0 . 00 0 . 00% 34 Printing & Publications 17399 . 00 0 . 00 0 . 00 % 35 Subscription/Dues/Memberships 0 . 00 0 .00 #DIV/0 ! 36 Insurance 0 . 00 0 . 00 #DIV/01 37 E ui ment:Rental & Maintenance 0 . 00 0 . 00 # DIV/0 ! 38 Advertising 0 .00 0 . 00 #DIV/01 39 Equipment Purchases : Ca italExpense 0 . 00 0 . 00 . #DIV/0 ! 40 Professional Fees (Legal , Consulting) 12 , 500 .00 81500 .00 68 . 00% 41 Books/Educational Materials 0 . 00 0 . 00 #DIV/0 ! 42 Food & Nutrition 0 . 00 0 . 00 #DIV/0 ! 43 Administrative Costs 0 .00 0 . 00 #DIV/01 44 Audit Expense 0 . 00 0 .00 #DIV/0 ! 45 Specific Assistance to Individuals 0 .00 0 . 00 #DIV/01 46 Other/Miscellaneous 0 . 00 0 . 00 # DIV/0 ! 47 Other/Contract 0 .00 0 .00 #DIV/0 ! 48 TOTAL $48 , 158 .00 1 $8 , 500 . 00 1 17 . 65% W20/04 e 4 22 Carmsahfty Chkkm Cars Resources, bhc. Psyd*lop Services Ctaldren's Ser&m Advisory Cortmlttae UNIFORM GRANT APPLICATION EXPLANATION FOR VARIANCES OF 15% OR MORE TOTAL PROGRAM BUDGET AGENCYIPROGRAM NAME: FUNDER: UNE ITEM EXPLANATION FOR VARIANCE roI MAX #D[V10l 90 LIE f #DfV t Mly/01 #D[t/ #DFV rot rot #DIVro[ #euro[ #QW101 #DNroI #DfVro! WALUE1 The utilities are higher since the purchase of the building at 1801 24th Street and will be higher after renovations are complete and utlifties space is in use. CCCR purchased a building during this year. The purchase of the building brought with it taxes and other expenses that did not exist Occupancy ulld Grounds) when the agency wasrenfing an office. #DFVal #Dfvrof #DNrof 1 httDtV t #D[Vro1 1 #DNro1 NPAW s� 94 23 COMMuMly Chiden Care Resarces, Inc. PsYcivibOkal Services CM'Idren's Servkes AdWwy Carw ittee UNIFORM GRANT APPLICATION EXPLANATION FOR VARIANCES OF 15% OR MORE FUNDER SPECIFIC BUDGET AGENCYIPROGRAM NAME: FUNDER: UNE ITEM EXPLANATION FOR VARMNCE #DIVroI rol #DIVIOf i WIW #1XV/01 I uoly I roI #1XVrol Total program and funder spec jc budget includes United Way portion for psychological services of $4000. No increases requested. Professional F (Legal, ConsuMn Funding request of $8500 same as 2003-2004 request. Po XXV101 #DIV I #DIVPoI #DIVIOf Mn /Lot s� ee 24 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 - F 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 : Abby Walters , Executive Director/CEO Community Child Care Resources , Inc. (CCCR) 1801 24th Street Vero Beach , Florida 32960 2 . Venue ; Choice of Law: The validity, interpretation , construction , and effect of this Contract shall be in accordance with and governed by the laws of the State of Florida , only. The location for settlement of any and all claims , controversies , or disputes , arising out of or relating to any part of this Contract, or any breach hereof, as well as any litigation between the parties , shall be Indian River County, Florida for claims brought in state court, and the Southern District of Florida for those claims justifiable in federal court . 3 . Entirety of Agreement : This Contract incorporates and includes all prior and contemporaneous negotiations , correspondence , conversations , agreements , and understandings applicable to the matters contained herein and the parties agree that there are no commitments , agreements , or understandings concerning the subject matter of this Contract that are not contained herein . Accordingly, it is agreed that no deviation from the terms hereof shall be predicated upon any prior representations or agreements , whether oral or written . It is further agreed that no modification , amendment or alteration in the terms and conditions contained herein shall be effective unless contained in a written document signed by both parties . 4 . Severability: In the event any provision of this Contract is determined to be unenforceable or invalid , such unenforceability or invalidity shall not affect the remaining provisions of this Contract , and every other 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 - ACORD. CERTIFICATE OF LIABILITY INSURANCE U022 09 - 09DATE - 2004 PaooucER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION SID BANACK INSURANCE ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER . THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 222809 P : ( 772 ) 562 - 3369 F : ( 772 ) 562 - 3466 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW . 2045 14TH AVENUE VERO BEACH FL 32961 INSURERS AFFORDING COVERAGE INSURED INSURER A: Hartford Underwriters Ins Co INSURER B: COMMUNITY CHILD CARE RESOURCES , INC INSURER C : 1801 24TH STREET INSURER D : VERO BEACH FL 32960 INSURER E : COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED . NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE 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. INSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LTR DATE MM/DD/VY DATE MM/DD/YY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY FIRE DAMAGE (Any one fire) $ CLAIMS MADE U OCCUR MED EXP (Any one person) $ PERSONAL & ADV INJURY $ I GENERAL AGGREGATE $ GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ j POLICY JECT LOC I AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS )Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO EA ACC $ I OTHER THAN AUTO ONLY : AGG $ EXCESS LIABILITY _ EACH OCCURRENCE $ I OCCUR u CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE I $ RETENTION $ $ TATUTH- WORKERS COMPENSATION AND WCR I 1' LIMIT X O TOR R A EMPLOYERS ' LIABILITY 21 WE C DQ 84 2 2 10 / 14 / 04 10 / 14 / 05 E .L . EACH ACCIDENT s500 , 000 E . L . DISEASE - EA EMPLOYEE s500 , 000 E.L . DISEASE - POLICY LIMIT s500 , 000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDO RSEM ENTIS PECIAL PROVISIONS Those usual to the Insured ' s Operations , Indian River County is also an Additional Insured per the Business Liability Coverage Form SS0008 . CERTIFICATE HOLDER I X I ADDITIONAL INSURED; INSURER LETTER: CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE ( 10 DAYS FOR NON- PAYMENT) TO THE CERTIFICATE Indian River County HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO 184 25th Street OBLIGATIONREPRESENTOR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR Vero Beach , FL 32960 AUTHORIZED REPRESENTAUVE ACORD 25-S ( 7/97) a ACORD CORPORATION 1988 I I DATE f ACORD. CERTIFICATE OF LIABILITY INSURANCE U022 09 - 09 . 2004 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION SID BANACK INSURANCE / PHS ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER . THIS CERTIFICATE DOES NOT AMEND , EXTEND OR 1227667 P : ( 866 ) 467 - 8730 F : ( 877 ) 538 - 8526 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW . Pe 00 BOX 29611 CHARLOTTE NC 28229 INSURERS AFFORDING COVERAGE ' INSURED INSURER A: Hartford Ins Co of the Southeast INSURER B: COMMUNITY CHILD CARE RESOURCES , INC INSURER C: 11801 24TH STREET INSURER D : I VERO BEACH FL 32960 INSURER E : COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED . NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE 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. INSRPOLICY EFFECTIVE POLICY EXPIRATION LTR TYPE OF INSURANCE POLICY NUMBER DATE MMIDD/YY DATE MM/DD/YY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1 , 0001 000 A COMMERCIAL GENERAL LIABILITY 21 SBA FP5 9 7 3 10 / 14 / 04 10 / 14 / 05 FIRE DAMAGE (Any one fire) s300 , 000 CLAIMS MADE U OCCUR MED EXP (Any one person) I $ 101 000 X BUS1neSS Llab PERSONAL & ADV INJURY $ 1 , 000 , 000 GENERAL AGGREGATE s2 , 000 5 0 0 0 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG s2 , 000 , 000 POLICY I I RO PECT X LOC J AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT A ANY AUTO 21 SBA FP5973 10 / 14 / 04 10 / 14 / 05 ( Ea accident) 1 $ 1 , 0001 ,000 ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS ( Per person) X HIRED AUTOS BODILY INJURY $ X NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ IPer accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO i OTHER THAN EA ACC $ AUTO ONLY : AGG $ EXCESS LIABILITY _ EACH OCCURRENCE $ OCCUR u CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND WCTORY IMITS STATU- OTH- EMPLOYERS ' LIABILITY ER I E .L . EACH ACCIDENT $ E .L. DISEASE - EA EMPLOYEE $ E .L. DISEASE - POLICY LIMIT $ OTHER I DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Those usual to the Insured ' s Operations . Indian River County is also an Additional Insured per the Business Liability Coverage Form SS0008 . CERTIFICATE HOLDER 1 X I ADDITIONAL INSURED; INSURER LETTER: A CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE ( 10 DAYS FOR NON- PAYMENT) TO THE CERTIFICATE Indian River County HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO 1 84 O 25th Street OBLIGATION OR UABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. Vero Beach , FL 32960 AUTHORIZED REPRESENTAJWE ACORD 25—S ( 7/97) ° ACORD CORPORATION 1988 INTERNAL REVENUE SERVICE DEPARTMENT OF THE TREASURY DISTRICT DIRECTOR 401 W . PEACHTREE ST . NW ATLANTAi GA 30365 Emp I oyer Ide ) it i f ic : a % i !_; rl Il � nlber : �1dte : 05 - 05 :. " 16 � M l i l Case Number : l.t J 5 ^ 50740 9 C016MUNITY CHILD CAINE RESOURCES INC Contact Perril,lri : 31r-� G CARDINAL DRIVE SUITE J200 ROBERTA VAN 'fl- ' ER VERO BEACHi FL 32963 Contact � Telephone N' umbe:Dr " ( 41(i 4 ) J J '. - 0 1 •�1 .5 Accounting F'eriod Endlilg : Jure 30 Foundation Si: atus Clas < > ifio: .ati ,-: n : Ad,yance Rul iiiQ Ju ' y i5 : 19914 Advance Ruling. F' Ci . d ds : Jure 301 _ 99 = - - Addendum App ie _ : Yes Dear Applicant : Eased on information You supplied , and assum : ilc your o: ,, ; , rdtltTot s si1II he d stated i n your app I i cat ion f or recogn i t i on of exempt i on 1•ie have deter- nl i ned y ;: ., are exempt from federal income tax under section 501 ( a ) : f the Ini_ err: al Revenue Cade as an organization described in section 501 ( c ) ( 2 ', Because you are a nel-rly created organiZation > !-ie are not noi-1 rilal. ing a final determ i nat i or. of your foundat i status under section 0:-: 09 ( a ) of the CiDde . Ho Wever , we have determined that you can reasonably e ), Pect tj:) be a pub l i c l s! supported organization described in sections 509 ( a7 ( 1 ) <, rld 170 ( b ) ( i ) ( A ) ( vi ) . Accordingly , during an advance rul ing period you wi l I . treated as a publicly supported organization9 and not as a private foundation . This advanc . rul ing period begins and ends on the dates shown above . Within 90 days after the end of your advance ruI ing periods y fu must send us the information needed to: determine whether you have ^let: the req u i r e - ments of the applicable support test during the advance ru 1 i n gper i o C, . I VI-6 u estab I i sh that yo u have been a pub I i c l y supported organ i gat i o; n , Sie:' 6-ii I I c i a = s i - fi' you as a section 509 ( a ) ( 1 ) or 509 ( a ) ( 2 ) organ _ dtion as I1:) ng tis you. conitlnue to meet the requirements of the applicable support test . If you d not meet the public support requirements during the advance- ru I i ng peri cid l we )-ii I I classify you as a private foundation for future periods ., Aisog if s•ie cla - �. ify you as a private foundations we s•iiII treat you as a private 'iounrlation front ,/ our beginning date for purposes of section 507 ( d ) and 4940 . Grantors and contributors may rely on our- determination that: you are not a private foundation until 90 days after the end of your advance ruiing . perior_• . If you send us the required - information i-iithin the 90 daysi grar. toirs and contributors may continue to: rely on the advance d :_• term i nat i on unt i I we make a f i na I determination of your foundation status . If we pub Iish a notice in the Internal Revenue:, Buiietin stating that we Letter 1045 ( DO / C10 a COi* MUNITY CHILD CASE RESOURCES INC W i I l no : onger treat yctu as a publ i c- l y supported of gan i zat i or, , grantors and coiltr i b utors may not rely on this determination after the date 4: e pub l i sh the notice . In additioni if you lose your status as a publicly supported organi - -�vat i on , and a grantor or contributor pias responsible f _, r : r_: r s a s as-iarr cif , the act or faiIure to act , that resulted in your loss of such status , that person may not rely on this determination from the date of the act or faiIure t „ act . A l sc' , if a granter or cs.-Intr i butor learned that we had given not i ck that you would be removed from classification as a publicly supported organi , atic, n , thea that person may not rely on this determinati �� n as � � f the date he or she acquired such kr. c, ssledge . If you change your sources of support , your purpc' aeS% , chareact _ r : or rlethod Of n1 lease let s know r, r: � , atir, , h change ;, - p P _ s• . s _ s�t � can consider- the effer.. � c: f the your �= xer.� pt status and foundation stAtus . If u amend y „ y ' _ ur � r' ean i gat; i _� na I document car bq l asss , please send us a copy of the amended docum _ nt c r by l as-? s; A i sol let u = 'r.. no, �-s all changes i. n your name or address , As of January i , 19 �04 , you are liable for social security taxes under" the Federal Insurance Contributions Act on amounts •. f $ 100 or mcore you pay to each of Your employees during a calendar year . You are not liable for t • Y " he ta :>: imposed under the Federal Unemp l c; yment Tax Act ( FUTA ) . Organizations that are noOLPt private foundations are not subject to the pri - vate foundation excise taxes under Chapter 42 of the Internal Revenue Cclde . Hi:, }•jever9 you are not automatically exempt from other federal excise taxes , If you have any questions about excise , emp I oyment , or other federal taxes , , i ease let us knowl , ' Donors may deduct contributions 'Co you as provided in sect i c) II 1 G c, f the Internal Revenue Code . Bequests , legacies , devise <_. , tr- ar. sfers , or gifts tc• t,' ,-, '„ or for your use are deductible for Federal estate and gift tax purposes if they meet the app l i cab l e prov i s i ons of sect i ons 24551 2106 , and '2522 ,-, f the d , Donors may deduct contributions - o you only tj_, the extent th ._, ttheir contributions are gifts , with no consideration received ., Ticket purcjases and similar payments in con ,juncticin with fundraising events r:iav not nC� cesSarl iy qualify as deductible contributions , depending on the circumstances . Revenue Ruling 67 - 2469 published in Cumulative Bulletin 1967 - 21 on page 1041 gives guidelines regarding when taxpayers may deduct payments for admissi n to , •• r other participation in , fundraising activities for charity . You are not required to file Form 9907 Return of Organization Ex empt Fri- in Tax , if your gross receipts each year are normally $ 2 .'_11000 or less . If you receive a Form 990 package ir. the mail , simply attach the label provided , check the box in the heading to indicate that your annual gross receipts are normally $ 257000 or less , and sign the return . If you are required to f i le a return you must f i le it by the 15th day r_ f the fifth month after the end of your annual accounting period . We charge a Penalty of $ 10 a day whey a return is filed late , unless there is reasonable Letter 1041 ( DO / CG ) A COMMUNITY CHILD CARE RCSOURCES INC cause for the delay . However , the ma ;; imum penalty ? e charge cannr, t exceed $ 5 , 000 or 5 percent of your gross rete i pts for the year . s ? h i c rev -, r is, less .ss . We may also charge this penalty i f a returr: i s not camp l ete: . S �; , p l :: ase be sure your return is complete before you fi ': e it . You are not required to file federal Income tax returns unless yiill are subject tc, the tax cin unrelated business income under s (_• cticin 511 of t: he C -idem If you are subject to this tax , you must f i le an incclme tax ret: ur- li on form 940 — T , Exempt Organization Business Income Tax Return . In this letter- we are not. determ i n i ng whether any of your present or prop ,.-.: sed act 1 v i t i e '.> are unrc - • — I ated trade or business as defined iii section 513 of thc? i; c : , You need an employer identification number cvC8n ( f you Ilave 110 employees ., If an employer identification number s-? as not enterecd on v0Ur applicaticin , s•? e s ? ill assign a number to you and advis � you of it . Please us _ that number on a ! I returns you f i I is and in a l l - corr ; xspondence with the Intel- n3 1 Fri' everlue Service ., ' If we said in the heading crf this letter that an addendum applies , the addendum enclosed is an integral part of this lettcar . Because this letter could help us resolve any questions abc: ut your exempt status and foundation status , you should keep it in your permanent. retards . If you have any quest i ons , please contact the person s•? hi:Ise n8lime and telephone number are shown in the heading ---If this letter , Sincerely yours , 1ty\� c � Nelson A . Brooke District Director- Enclosure ( s ) : Addendum Form 87 ? — C Letter 1045 ( 110 / Ml , - 4 - COMMUNITY CHILD CARE RESOURCES INC You are required to make y ,lur annual return zvailab ie for puliiic inspection for three years after the return is due . Y �3u are also requir , d to make available a copy of your exemption appIicationi and supporting documents ? and this exemption letter . Faiiure to , make these documents available for public i aspecti on may subject: you to a p :_ na 11Gy of $ 10 per day fcir each day there is fa i I ure to comply ( lip to a maximum of sFl000 in ti •rP cos - c• f an annual return ) . Sri; Internal Revenue Service NI:, i; i re ^ ^ - 1 C) , jg , , . �74 . B . 454 , ` or r:� dd i t i ono I information . If your organization conducts fund - raising events such as bei , ef i t: d i nners > auctionss membershi drives • P etcc7 ;there scimething of value i ' rc-, ce i ved i n return for ccintributions ± you caro help your doncir avoiti dlr 'i : cult-- i c; with their income tax returns by ass i st i nq them in determ i n Ing thc, proper tax treatment of their contributions . Tc d •. th i = you : hou i u = in ad a1 -1 . e oaf thy- events determine the fair mark #-; fet value . f the benef it rc.vice i vi - d anfl estate it in your fund -- raising materials such as sol icltat l7 'I- Icket '. :. ° ani! receipts in such a way that your donors can dcterminim how much is deductible and how much is not . To assist you in this , the Service has issued Publicaticrn 13917 Deductibility of Payrients Made to Charities Conducting Fund - Raising Event : . You may obtain copies of Publication 1391 from your local IRS, Office . GuideIines for- deductible amounts are aIso set forth in Reversue RuIina 67 - ? -10: 6 + 1967 - 22 C . B . 104 and Revenue Procedure 90 - 12 , 1990 - 1 C . B . 471 and Revenue Procedure 92 -- 491 1992 - 26 I . R . B . 18 .