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Home My WebLink About2004-229S oftirm I, 7� Indian River County Grant Contract Dy ` ZZq 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 Cultural Council of Indian River, (" Recipient") ; of: Cultural Council of Indian River Courthouse Executive Center 214514 th Avenue - Suite 11 Vero Beach , Florida 32960 Summer Camp 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 , 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 COTY COMMISSIONERS By: Ot 1c: C.1 , I Arthur R . Neulber , Cha ' rm n BCC Approved : Attest : J . K. Barton , Clerk By Deputy CI.& Approved : Jos h A . Baird County Administrator o e and legal sufficiency: Maricern E . F , Assi n my RECIPIENT : f Lnit By: '� �, CULTURAL COUNCIL OF INDIAN RIVER COUNTY - 4 - EXHIBIT A [Copy of complete proposal/application] - 1 - Cultural Council of Indian Riva Courdy; Summer Cultural Camp; Children's Services Advisory Committee of Indian Riv County 2004 PROGRAM COVER PAGE Executive Director: Mary Jayne Kelly Email : mjkelly@cultural-council. org Address : 2145 14a` Avenue, Suite 11 Telephone: (772) 770-4857 Vero Beach, Florida 32960 Fax: (772) 770-3403 Program Director: Annie Astley Email : info@cultural-council. org Address : 2145 14Avenue, Suite 11 Telephone : _(772) 7704857 Vero Beach, Florida 32966 Fax: (772) 770-3403 >< uW.ffid u a am ' Frionty Need Area Addressed: Mental Wellness: Childcare Access Brief Description of the Program: Two week summer day camp, scheduled in the two weeks prior to the start of the school year, emphasizing the arts through the use of team work and visual, musical and performing arts . Held during a time when other options for child care are limited . Culminates in a Grand Finale a production based on the six pillars of Character Counts ! Taxonomy Codes : RB450, RB480, RB - 183 , RB -500 ,RB -660 Ift SIMMRT - Enter Information In The Black Cells Only) t1:0' Total Proposed Program Budget for 2004 / 0 : 62 , 570 Percent of Total Program Budget : 84 . 7 % Current Program Funding ( 2003 /04 ) : $ 53 , 000 Dollar increase/ (decrease ) in request : $ - Percent increase / ( decrease) in request * * : 0 . 0 % Unduplicated Number of Children to be served Individually : 251 Unduplicated Number of Adults to be served Individually : - Unduplicated Number to be served via Group settings : Total Program Cost per Client : 249 . 28 * * If request increased 5 % or more, briefly explain why : No Increase Requested If these funds are being used to match another source, name the source and the $ amount: _ The Organization 's Board of Directors has approved this application on (date . May 13 , 200 Sheila B . Tucker Name of President/Chair of the Board Signature I . (i Mary Jayne Kelly Name of Executive Director/CEO Signature el i eI ' y r r m <r ,�,�Y NeI eI is R i' t a � yy '�"t i Iry •ir st iY��! r, Y? � ! 4 1 x 5 S , t 5f'Salin� R K<A Sr J �t ' ,� _ 3 } � r y (((„'� r ' eIle, r !- ! y % Y ' ..4 " ef xnY FJM1' `d4. , . Y""t7t,' 'x"SE'S ro Cultural Council of Indian River County; Summa Cultural Camp; Children's Services Advisory Committee of Indian River County 2004 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 Cultural Council of Indian River County is to nurture a cooperative environment in which cultural and educational organizations and individuals may thrive and thereby, enrich the quality of life in Indian River County for all residents and visitors . The vision of the organization includes being an integral part of the community by being involved, cooperating and collaborating with all entities that desire arts instruction, appreciation, planning or opportunities. 2. Provide a brief summary of your organization including areas of expertise, accomplishments and population served . The Cultural Council of Indian River County has been the county' s designated Local Arts Agency since 1995 . This designation requires this organization to promote cultural opportunities for the community, support cultural organizations and individual artists . It also requires that the Cultural Council work with other entities that desire to include the arts in their programs. This organization' s area of expertise is in collecting and disseminating cultural information to anyone in the County that requests it. We provide technical assistance in finding resources, such as qualified art instructors and supplies. We also work with other organizations to provide cultural experiences that enhance their mission. This organization has done this for many years through an after- school program and a Summer Cultural Camp, both of which emphasize the arts . All of the children are on the free or reduced lunch program, where economic indicators are less than favorable for extras such as arts instruction or opportunities . Instructors serve as positive role models, while teaching skills that can serve as a coping mechanism, career choice or a meaningful activity. The after-school program has retained many students for several years, having started in elementary school, now they are in high school. These students volunteer their time to assist the younger students during the camp . The after- school program has served about 60 children per school year and the summer camp has served approximately 200 children and teens in any given year. The response from participants and parents has been overwhelmingly positive. However, the program is at a stage where it must evolve for two purposes : to expose more children and teens to the arts and to nurture those students that exhibit exceptional talent. Building on the accomplishments so far, the Cultural Council would like to put arts instruction in locations where children already go after school. We would like to share our experience and expertise with other organizations so they can enhance their programs and we can all enhance the children' s experiences in after school care. We would like to provide educational cultural field trips to increase the access to cultural facilities . It has been demonstrated that learning a skill in the arts helps a child to learn discipline while achieving a goal . A child ' s elf esteem is enhanced when the skill is performed or displayed , t 01 It ya � 'V 3`;t � J ♦ya i : n to ax •4...�ei Mty 'Y!t . r� a„, v Va+.NI V� XIt it Cultural Council of Indian River County, Summer Cultural Camp; Children's Services Advisory Committee of Indian River County 2004 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: Limited number of affordable programs available to working parents in the two weeks prior to the start of school. Who : Children with risk factors such as qualifying for the free or reduced lunch program, living in single parent homes, alcohol, tobacco or drug use, symptoms of depression, displaying anti-social behavior or dropping out of school Many families have single parents or both parents working full time. Many parents find themselves stretched to the limit trying to provide just basic needs . Time constraints force us to use the time we have efficiently and wisely. Where: The numbers of school aged children living in Indian River County are located in the Western, central and Southern ends of the County. The children with the greatest socioeconomic need are centrally located in the County. Summer programs offered at this time dwindle, programs for teens are limited. The Summer Cultural Camp offers productive, supervised activities that give children tools for living. The Summer Cultural Camp offers transportation to a central location in the morning (GYAC) . From there, field trips and classes are arranged . transportation Data : Figures from the Florida Department of Education indicate a steady increase in students eligible for the Free/Reduced Lunch Program statewide, Indian River County shows 39% of the children in the school system qualify for this program, which translates into 5935 eligible children. Data from the Needs Assessment conducted in 2002 by the Children' s Services Advisory Committee indicated that the percent growth in impoverished families with children in Indian River County had a 46% rise from 1990 —2000 . A subsidized childcare sites and wait list chart in the same report indicated that there is a capacity for 182 in- school children, but the need is for 250, revealing a gap of 68 needing a place for childcare after school. The Cultural Council is identified as an asset to the community in that same report regarding the service that we currently provide to the children. The focus on the need for mental wellness in our children was evident in the report, especially for programs that prevent mental distress and illness . This program provides such a focus. 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) The Indian River County Recreation Department offers "Pool Days, Not School Days" for part of the time this camp is offered . The City of Vero Beach Recreation Department is not offering programs at this time. Some community _ organizations are offering arts classes but the cost is high and the hours of operation do not fit a working families ' schedule. Boys & Girls Clubs, will be operational at this time, Gifford Youth Activities Center is hosting the Summer Cultural Camp . Dasie Bridgewater Hope Center and Children' s Home Society' s are operational. b) All these locations are already filled to capacity during these two weeks. vest Ysss... Zr 1 o- 4 r Y45^„ "C C'. tea. h PSC i '4 t r^ 0001VIN A 41 I Fr.Rr t pug xa , yx u J 'tw r .L rk$ ^ ' t ,s t� P• a f M Y x" t AWA . ..'3 'S wp •04 ., g ,' !n .. . . .. . ,a7' • ,. _,. . ✓�� : . � } +t�.,.i...,• . a/' '%f"t ^i • Cultural Council of Indian River County-, Summer Cultural Camp; Children's Services Advisory Committee of Indian River County 2004 C. PROGRAM DESCRIPTION (Entire Section C, I — 6, not to exceed two pages) 1 . List Priority Needs area addressed. FOCUS AREA I: Mental Wellness Issues in children ages 747 This program improves the capacity of children in Indian River County to succeed to adulthood in a safe, healthy, and productive manner by meeting the following objectives : Promotes enhanced emotional and social skills; Provides early intervention screening for children; Promotes life skills training and effective use of emotional and social skills; Promotes independent living skills; Promotes accessible locations for healthy, productive activities . FOCUS AREA III: Childcare Access in children ages 747 This program supports caregivers, a child ' s most important resource, to be and do what is needed to shepherd children to adulthood in a safe, healthy, and productive manner by meeting several stated objectives. Increases the availability of affordable quality childcare; increases access to affordable extended/after school programs; increases access to cultural and ethnic activities; increases tutorial and mentoring programs . 2. Briefly describe program activities including location of services. The main activities of this program are chosen to provide children and teens with creative tools to help them succeed to adulthood in a safe, healthy and productive manner. Community artists teach the classes in visual, performing and musical arts. The Summer Cultural Camp culminates in a Grand Finale Production, where parents and guardians are invited to watch the results of their efforts. The production involves cooperation and discipline on each student' s part. Field trips to cultural venues, such as he Environmental Learning Center, McKee Botanical Garden, the Vero Beach Museum of Art, Vero Beach Theatre Guild and Riverside Theatre are part of the enrichment experience . Classes are held in many of these locations, as well as the Gifford Youth Activities Center. Recreational activities, such as swimming and bowling are also a part of the program activities . An anti- drug use message is part of the program, presented by the Substance Abuse Council's Deep Impact presentation. 3. Briefly describe how your program addresses the stated need/problem . Describe how your program follows a recognized "best practice" and provide evidence that indicates proposed strategies are effective with target population, Several studies cite the use of the arts as a prevention tool and for positive development of children. A recent report issued to the Florida Senate from the Committee on Criminal Justice in December 2002, entitled "Review Effectiveness of Juvenile Programs that use a Visu#1 and Performing Arts-Based Intervention Approach" summarized numerous studies that illustrate the positive impact these types of arts programs, especially ones containing mentorship opportunities and relationships to the community, influence at-risk children toward positive goals and behaviors. (The Arts and Prosocial Impact Study, Rand, 1999 .) Students who have been consistently involved in music and theatre exhibit higher levels of success in math and reading. (Secretary 's Commission on Achieving Necessary Skills, U. S . Department of Labor, 199 1 ) A lengthy national project that studied children form low income backgrounds found that those exposed to arts learning were more likely to be class officers, involved with math and science fairs and to be recognized with. a writing award . (Community Counts: How Youth Organizations ., Matterfor Youth Development), Shirley Brice Health, Milbrey W. McLaughlin, 2000 . Exposure to arts impacts the developmental growth of children and helps to equalize the learning curve ¢_ „ that cuts across diverse socio-economic backgrounrxs (UCIA Imagination Project, Americans ; ' (L: 6r the Arts 1998) ; By providing arts opportunities and choices at a young age, children become ; , motivated and engaged" g in this health "outlet' fore resslon. 01 , n F � , d x 7 , srz� i } �.t - Y . fa .yB t i t^ .� Y?l •�kx s , gy'•,r Oro I t I I I Cultural Council of Indian River County; Summer Cultural Camp; Children's Services Advisory Committee of Indian River County 2004 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). Portion of Salary : Bookkeeper (1) : Responsible for organization of records and administration of payments to contracted personnel and program related expenses . Keeps records pertaining to all grant expenditures, prepares request for reimbursements and quarterly reports . 3 % of time (5hours per month) _ $ 840 Professional Fees : Camp Director (I) e Reports to Executive Director. Experience required with arts and education, organizes classes and locations of classes, represents Cultural Council with instructors, parents and students . Assists parents with locations and transportation. Coordinates evaluation administration and collects required documentation from instructors and students. Required : Bachelor' s Degree; Contracted Position for 518 hours for entire project. Prorated over the months of April ( 13 ), May (52), June ( 150) & August ( 125) $ 16 . 50 per hour = $ 8547 Creative Leaders _(3) : Reports to Camp Director. Each responsible for cohesiveness of a discipline : Visual, Musical, Performing Arts. 110 hours Total $ 15 per hour = $4950 Arts Instructors (16) : Reports to Producer in specified area. Provides lessons in a specific discipline such as visual, musical or performing arts . Required : Experience teaching art to children, experience with a specific artistic skill. Contracted Position for 30 hours Total = $ 8640 Program Evaluator (1 ) : Reports to Executive Director. Administers evaluation of program, interprets findings and screens for potential mental health risk factors for referral. Required : Bachelor' s degree in Psychology or related field, Advanced Degree in Counseling, Registered Art Therapist. Contracted Position for 20 Hours Total. @$20 per hour = $400 Contracted Staff: Supervisors (16) : Reports to Producer in specified area. Responsible for assisting Arts Instructors and supervising a group of children. Assists with children needing special assistance or attention in the group . 40 hours per week for two weeks . 80 hours total; Total= $ 12, 800 Administrative Counselor ( 1) : Reports to Camp Director. Responsible for attendance and food service records. Manages arriving campers and departing campers . Coordinates field trips and transportation issues . 95 hours for total project $ 15 per hour Total $ 1425 5. How will the target population be made aware of the program ? First, students that have already participated in the program receive notification by mail. Flyers are distributed to Boys & Girls Clubs and Dasie Bridgewater Hope Center. Spaces arereserved for the collaborative partners. This includes, the Homeless Assistance Center, United for Children: Foster Care Children, Youth Guidance, Hiz Kidz, Gifford Youth Activities Center and the Truancy Prevention Program. Churches and othAr community organizations receive information by mail. A public notice is published in the newspaper and the county recreation department publishes the information in their summer brochure. Openings usually fill up quickly with this outreach but word of mouth brings more families to inquire. 6. How will the program be accessible to target population (i. e. , location , transportation, hours of operation) ? qi Li . Children will either take a bus to their loCatlori and parents/guardians will pick them up, or , . x agents/ ardiaris rovide, trans r ortation: Hours of Operation are 8 : 00 am — 4 pni, Mon: ,=- Fri. .-,i,', . ' E t ? 41. t aur eLs J SPv �k H �--4a l' Y i + ^a wY'S R x Nil, a x ty +at' Vr l, a Y z + ` Cultural Council of Indian River County; Summer Cultural Camp; Children's Services Advisory Committee of Indian River County 2004 D. MEASURABLE OUTCOMES (Entire Section D not to exceed two pages) OUTCOMES ACTIVITIES Add all of the elements or the Measurable Outcome (s) Add the tasks to accomplish the Outcome(s) To increase the knowledge of theatrical terms Can the first day of camp when entire group is and definitions by 50% for children attending assembled, administer theatrical pretest of the Summer Cultural Camp during the two theatre terms. Collect tests weeks of camp by a pretest and posttest group assessment on the first and last days of camp . 1 . 2 : Baseline: Answers from the pretest group On the last day of camp before the Grand assessment on the first day of camp . Finale, conduct posttest of theatre terms. Collect tests 1 . 3 : Compare and contrast first day answers with answers from last day. 1 . 4 : Compare records of 2003 —2004 to 2004 — X 05 . .: shay � � (t � f, :✓ t � ' i r� n � v .t2 WW fr ;d.:r`, A ` ✓ a . ? i ,, x i tzr 1. "tPr• `:r F g �""rN o^fyy`'y � �. ' +FMsx o- s ax 7 u- nli'ry�yy b e U t Cultural Council of Indian River County, Summer Cultural Camp; Children's Services Advisory Committee of Indian River County 2004 2 . 2. 1 : To increase the number of children screened Administer Silver Drawing Test as pre-test to for developmental risk factor indicators by participants in program in the first month of 10% in one funding year as reported by the program being operational. Silver Drawing Test of Cognition and Emotion. 2 . 2 : Baseline : Pre-Test Scores on the Silver Administer Silver Drawing Test as post-test to Drawing Test of Cognition and Emotion. participants in the last month of program being operational. 2; 3 : Identify children with risk factors indicated by test results . 2 . 4 : Notify parents/guardians of children identified with risk factors to appropriate referral sources. 2 . 5 : Compare Pre & Post Test Results F � �YkYpn m �sxxsl s h��Y "'`� vao rty,."�1 . � v �L^".,'$ y"' `h, '�• �'x. jt+ Gf J' - ++ r � ff x r . �4' a .y r .pA I s d .. -r W xi e i N i' tet' .y , 'w3°' t—• 1 .r ' < r} eY a •`�i1'r�nsx'J § x�6f�Yy ij c N �' 61 r .� ry - yyTT 4 + , t p t4- 4 y- iT rt M1 9 4. t � Cultural Council of Indian River County; Summer Cultural Camp; Children's Services Advisory Committee of Indian River County 2004 E. COLLABORATION (Entire Section E not to exceed one page) 1 . List your program' s collaborative partners and the resources thata they are providing to the program beyond referrals and support. (See individual funder requirements for inclusion of collaborative agreement letters. Collaborative Agency Resources provided to the program Indian River County Recreation Staff to assist with registration; Staff to manage Department and supervise groups of children; staff to lead activities Participation in evaluation Gifford Youth Activities Center Facilities for instruction Ongoing communication & assessment -Participation in evaluation Youth Guidance Referrals of teen volunteers Indian River County School Specialists Assist in identifying appropriate children for the cam Environmental Learning Center Facilities for Instruction Instructors Ongoing communication & assessment Laura Riding Jackson Foundation Facilities for instruction Instructors Ongoing communication & assessment Participation in evaluation United for Children: Foster Care Children Provide Children for Camp Hiz Kdz : Gifford Community Group Provide Children for Camp Truancy Prevention Program Provide Children for Camp ' r ` e ` 4N+ ° � t � - :1 6Friyr..b lq { , F��" t�6� °f (� � C4T • sg � rSu rid t� hSA"Fi e e ,a M''`+ r: ,� xr Y� ° r r r . ,, ", yam G i� > °' r off• �. �. °t `�`' x r � • � l , "" r rss „�.t a ix ♦° ir>bT } $ c "" 7.,°r- fa1 v' k ° '; An^ yh r 6E.. 7 v: 1 , 1 U r '9 ° r #'t aG.tri n r ''; �',� �`� py�` i i � e Cyt �s w� �` �t'a •t ", s S5'°� . i% 1�t : 8 • .C1 ,. y�, 1 ".s1 .,' '$�'C' . .r B.'�P. s. °,�'• ¢` . . � hY"�`{ "z . r •�-_ � 0}•dAhW :, h^_.. Cultural Council of Indian River County; Summer Cultural Camp; Children's Services Advisory Committee of Indian River County 2004 F. PROGRAM EVALUATION (Entire Section F not to exceed two pages) L 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 $ 19. Necessary data elements will be collected from referral forms, it will be indicated that the information will be used for grant reporting purposes only. Children that are participating in the free or reduced lunch program or have an additional risk factor identified by the student support specialist or teacher from the school and indicate that there is an interest in learning about the arts qualifies them for the program. The presence of any of these risk factors indicates the need for services and the indicated risk factors will be documented for reference in the database. This information will be shared with the appropriate staff, which will take it under advisement. 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 gettirg 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 in or follow-up on this data? • Referral Form for use by Instructors, Teachers and Student Support Specialists. • Database of participating students, including demographic information and indicated risk factors . • Administer Pretest of theatre terms and the Silver Drawing Test on first day. • Conduct Post-test of theatre terms and Silver Drawing Test day of Grand Finale. • Identify children with risk factors indicated by test results . • Notify parents/guardians of children identified with risk factors to appropriate referral sources . • Compare Pre & Post Test Results 3. REPORTING: What will you do with this - information to show that change has occurred ? How will you use or present these results to the consumer, the funder, the program , and the community? How will you use this information to improve your program ? The most important information gathered would be the presence of risk factors indicated by the referring entity, instructors during the ' course of the program or at the end of the program. Parents and Guardians will be involved in addressing these risk factors. A final report, including all test results will be shared with the funder. The Silver Drawing test results will be pooled with pyx, , , tfie researchers national data. All final re orts are o en to the ' ilblic for review: �e s �s3 yp, ^ p�� *v5y r {! i ��y ". •' S � tis - ��a�o- P ¢ .p, d5rt3b w 1 , INV at'g c F Zvi v" 5 4 a M " „P. ' . } 4' r l a i { $ 'Ye / J FI rA ,t L. i f1 s±� I Y f fF IVAN .F- ,f ` . '1 " C + L�'�� 'F' Cultural Council of Indian Rives County; Summer Cultural Camp; Children's Services Advisory Committee of Indian River County 2004 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 May 2005 • Contact all previous campers, previous staff, schools and collaborative partners; notify for applications. • Assemble referrals from schools, returning campers and collaborative partners. • Create updated da.abases • Assemble staffing • Secure Facilities June 2005 • Determine the Theme of Camp Program • Work with Producers to determine appropriate activities • Start working on supply list • Start framework for scheduling activities July 2005 • Finalize staffing • Finalize campers • Finalize classes August 2005 • Summer Camp Program is conducted • Conduct Pretest/Posttest; Silver Drawing Test • Identify children with risk factors indicated by test results . • Notify parents/guardians of children identified with risk factors to appropriate referral sources. September 2005 • Prepare Final Report r 19 a , Arm c y � Yf I y, Y Su 'f4�A �( I2 � t 9�0''Yn�S }e� {�f^ ` � " 'i • Y'++sPY W' s Y'� .` `' *�, c t �. , Cultural Council of Indian River County, Summer Cultural Camp; Children's Services Advisory Committee of Indian River County 2004 H. PROJECTIONS FOR UNDUPLICATED CLIENTS Number of Unduplicated Clients by Location Y. •.v v VHl l Wl t fiscal Year �}{'l,.•}.:.iyAyr{::vv::.. {:.;:.v .•... .a}2;.r.{ {.} . .;}.f,. r:i.:}:;. v ..r. . '::J.•-.•'r: :. •'•:: i�si'.;:+ :�•'��ri': �Y::}<,:v;.ytf;.j�:; ::'i,:::?r}:iL Location < <> rtt v< Budget 2003/04 g , W. . . . .. . .. . . ... . . ...... ... . . . . .. . .. . . Unduplicated Clients Unduplicated Clients Unduplicated Clients N. Indian River County 100 100 100 S . Indian River County 112 112 112 Indian River Co. Total 212 212 212 Greater Stuart Hobe Sound hidiantovm Jensen Beach Palm City Martin County Total Fort Pierce Port Saint Lucie St. Lucie Co. Total Other Locations TOTAL SERVED 212 212 212 0 to 4 - (Pre- school) 5 to 10 - (Elementary) 116 - 116 116 11 to 14 - (Middle) 96 - 96 96 15 to 18 - (High School) Total Children 212 - 212 - 212 - 19 to 59 - (Adults) 60 + (Seniors) Total Adults TOTAL SERVED 212 - 212 - 212 - s, e e z � t° � xh4 •ea• i � ' Y r ` v i A:F'" � � r p Cuftml Council of Indian River County Summer Cultumal Camp 2004 UNIFORM GRANT APPLICATION . BUDGET NARRATIVE WORKSHEET AGENCYIPROGRAM NAME: Cultural Council of Indian River County/Summer Cultural Camp FUNDER: Children's Services Advisory Committee - Indian River County - � v� odl f�rfdtsf� Hades � t7 1 Children's Services Council-SL Lucie 1491IN940W.A 2 Children's Services Council-Martin 3 Advisory Committee-Indlan River 53 000.00 53 000.0 88,000.00 4 United Wa SL Lucie County 5 United Way-Martin County 6 United Wa 4ndlan River Cou 7 Department of Children 3 FaItatat) ,_ .8 Cou Funds 133,400.9 Contributions-Cash 7232.69 5,700.10 ram Fees 11 Fund Raisl Events-Net 33.500_12 Saks to Public - Net 13 Membershl Dues 10,000.14 Investment Income 15 Miscellaneous 1 ,100,16 acts 3 uests - ""17 Funds from Other Sources5 320.00 . 8,000.1 8 Reserve Funds Used Tor O '�' - 19 In-Kind Donations poot lnctudg000.00 20 TOT5 552.69 SSJ 000.0 5279 700. �C� w trin?w'eitdri� �aiN ` lbpOi �'`� ;.S et � /l 21 Salaries - (must complete chart on next page) 375.00 375.0 59,480.00 22 FICA - Total salaries x 0.0765 - ;55 28.69 28.6 4,550. Retirement - Annual pension for qualified 23 staff 0.0 LffeMeaith - MedicaUDentaVStart-term ` 24 Disab. 0.0 Workers Compensation - # employees x 25 rate 0.0 Florida Unemployment - # projected 26 employees x $7,000 x UCT-6 rate 0.0 Executive Director 47t000.00_ 0.00 0.0 0.00 > ExecuOve Assistant 12,480.001 - 375.00 375.0 - 3•00 NDrvrol #Drvrot trorvrol #Orvrol #Drvrol qv,? " 4Cf AW1013 #orvrol #DiVrol #Drvrol #Drvrol " � i ;'a , z r y w " - ,v, ; ,�.pn '-4"eda�.:as*4'.rpy•r - _. - - #OIV/OI , itf Remaining positions throughout the agency Total Salaries •5u , ,.. $59,480. ..a:ur-? �_,� 375.00 � 375.0 "- ,M {. } elf? 'L`: q � f,y.y > ae Wit � . , h" `k, �' y4 ; at .. rP 4 s ' i ✓ �fs�e,. 9k t '� Y +, . � .�jyk� nv .. � ` v4l- la �* 1.'° # � f '�'� A � y 7 .c* 2!ei n � , l a CwS•9' :° d�e� '�,}�� ` � �'�i �y� ,:. ya N til .�; � ax bSYY v i > } � 4 tt F ' �}' i Ye " •. tra r'," yak l�4' y� ': ,r' 6 3. � $ �+ i i y,. Cultural Council of Wan River County Summer Cultural Camp 2001 4 - Executive Director 0.00 0.00 0.04 Executive Assistant 375.00 28.69 28.6 0 0.001 0.00 0.04 0 0.001 0.00 0. 0 0.001 0.00 0.04 0 0.001 0.00 O.Ocj 0 - 0.210.00 0.0cl - 0 0.001 0.00 0.04 0 O.Cq 0.00 .001 0 0. 0.00 0. 0 0.01 0.00 0.04 0 0.001 0.00 0.04 0 0.21 0.00 0. 0 O.D01 0.00 0. 0 0.001 0.00 0. 0 - O.00I 0.00 0. 0 0. 0.00 0.001 0 OX01 0.001 1 0.04 0 0.001 0.001 10. 0 5-cq 0.00 p, Total Funder Request FAnge Benefits S375.0q $28.6 S0. S0. $0.01 $0.001528.6 f iaw�> '��^t •T �r $ #f tr' 4 f � t � Z � � " r .x 1y 'a , AI c3st.r.5",;fi-t."fte' `�h3 '*• i J �S, }. [ t . S q � *. e - Y iJYaW� l �� ♦M12z{L .. iv Mia i J 'k�y� '6117 ' d t �f _• � q-n'G v �. � 1 tiro :. •yrt �a�s p2 t � �Yy "WE��&� t� ,�,�-y�, 'i "F . : /� ' �}�,r�ry T � �'� ^r4� � F��} �'"ti,ia r °'f M+ :` 4�y a n +�x��` 1�' � �• � ri'a�' Y . i • e '{ ' Cultural Council or Indian Rim County Summer Cultural Camp 2004 Travel-0a 4.000.0 4.000.0 5,000. 27 Travel costs for 2003 were $5153 - TravelfConferencealTrainin 0.0 0.0 3,5M04 28 1 Office Supplies 100.0 80.0 8W.04 23 $20 per month for 4 months =$80 Telephone 1140.0 1140.04,000. - $285 per month (one third cost for one One) - 4 months = $1140 per year, one One of three 30 used for program Postage/Shipping 148.0 148.0 4,4.500. 51 400 pieces of mail Q .37 per piece = $148 Utilities _. 0.0 _ 0.0 _. 0. 32 Included in occupancy - - - MaNNISRONAMA Occupancy (Building hL Grounds 1 .111 .0 1 111 .0 9,575. Mortgage/Rent $833 per month divided by three = 277.66 per month x 4 months = $ 1111 per year, Program uses one workstation 33 of three for 4 months per year Printing i Publications 90.0 90.0 10.000. 500 copies per month(D .03 = $15 per month - .. .. . x 4 months = $60; 1 Box of copy paper = 34 $30.00 Total = $90.00 r' °' Subsed on/DikeslMembershiP s 7 0 2 - 70.0 0.0 . .050. Dues for Arts for a Complete Education 35 $70.00 V1 NO av - = S1150.DD 9.000.0 50000 - .12,000. a Worman's Comp = $2450.00 CommerdaUGeneralInsurance= $4950 » Student Accident $450 Total 36 = $8987.83 E ui nt:Rental 3 Maintenance 0.0 0.0 4,DOO.DC 37 Advertising _. . 0.0 0.0 33,000.00 3 _ g Equipment Pumhases:Capital Expense 0.0 0.0 0.00 3 Professional Fees (Legal, Consulting) 22 537.0 22 537.0 90.350.00 Director (1 ) 518 hrsQ $16 = $8547; Creative s X, Leaders (3) 11 Ohre Q $15 = 54950; Art z Instructors (16) @5540= $8640 Evaluator(1) - - 40 20 hrs Q $20 = $400 TOTAL= $22,537 w BookslEducatlonal Materials 4,750.0 2.286.3 - 12.500. $250 per instructor x 19 (includes creative 41 leaders) instructors = $4750.00 Food 8, Nutrition _ . , _ . . _O.o 0.0 - 0. 4 Administretive Costs 6 528.0 0.0 43 10% of program cost = $4900.00 _ - - - - .... .. Audit Expense _ - - 1 250.0 1 ,250.0 - 41000. Independent Audit Review45 Specific Assistance to Individuals .- - 0.0 0.0 0.001 Other/Miscellaneous - 0.0 no e.000. 46 Regranting $8000 - - - - Other/Contract 14 425.0 14 425.0 7,726.01 Supervisors 16 Q $800 = 12800; - Administrative Counsleor 95 hrs @$15 per all hr- $1425; Recreational Counselor 20 hrs Q 4 $10= $200 TOTAL = $14,425 - • _ ,,, _ - - TOTAL EXPENSES 48 -» - $65552.69 552471 .0 $275,031 . ad I Y� fi t at t ;- M� '`k ks .•,t , , W .'^ 4t �r :. f. 9�r4 fi ♦y�. ^ yy _ � d - T 1 1 j�N i� 'M �+✓ i I � VP ,aq �"+ 5� >� x s 1>� � 4 Lx ,� !{~i;}R ��y� S� YW' Yi � T i * e�� ty �C 5 n11, yja��;T�� • '�4 � }e ": is C k N. . 3'. a .` +• '.� - it$ a f Qi a '" y,^r 't fi Wvt5 t r ° "" _ _ ' r `} - s 1AI . .'v'� 'x4 Cultuno Cound of Indian River canny Summer Cultural Camp 2004 UNIFORM GRANT APPLICATION TOTAL AGENCY BUDGET Cultural Council of Indian River County/Summer Cultural Cam FY 02/03 FY 03/04 FY 04105 % INCREASE FYE_09/30/03 FYE 09/30104 FYE 09/30/05 CURRENT VS, NEXT FY BUDGET A B C D ACTUAL TOTAL PROPOSED (coL C wL BycoL 8 REVENUES BUDGETED BUDGETED 1 Children's Services Council-St Lucie 0.00 #DIV/01 2 Children's Services Council Martin 0.00 #DIV/01 3 Advisory CommitteesIndian River 82 411 .00 88 000.00 88 000.00 0.00% 4 United Way-St Lucie County 0.00 f/DIV/01 5 United Way-Martin County 0.00 #DIV/01 6 United Way-Indian River County 0.00 #DIV/01 7 Department of Children & Families 0.00 #DIV/01 a County Funds 111 719.00 133 400.00 133 400.00 0.00% 9 Contributions-Cash 367200 5700.00 5700.00 0.00% 10 Program Fees 485.00 0.00 #DIV/01 11 Fund Raising Events-Net 23 097.00 3350000 33 500.00 0.00% 12 Sales to Public-Net 0.00 #DN/01 13 Membership Dues 10,36U.00 10 000.00 10 000.00 0.00% 14 Investment Income 173.00 0.00 #DIV/01 15 Miscellaneous 19639.00 11100.00 110000 0.00% 16 Legacies & Bequests 0.00 #DIV/01 17 Funds from Other Sources 21j643.00 87000.00 89000.00 0.00% 18 Reserve Funds Used for Operating 0.00 #DIV/O! 19 in-Kind Donations (Not Included In total) 2850000 0.00 #DIV/01 20 TOTAL 255 099.00 279 700.00 279 700.00 LL0.00% EXPENDITURES 21 Salaries !79027,00 54.00 59t480.001 59 480.00 0.00% 22 FICA 455000 4550.00 0.00°/23 Retirement 0.00 #DIY/0! 24 Life/Health 00.00 0.00 #DIV/01 25 Workers Compensation 0.00 #DIV/01 26 Florida Unemployment 0.00 #DIV/Ol 27 Travel-Daily 175.00 59000.00 5000.00 0.00% 28 Travel/Conferences/Training 350000 3500.00 0.00% 29 Office Supplies 11800.00 800.00 800.00 0.00% 30 Telephone 3 400.00 4 000.00 41000.00 0.00% 31 Postage/Shipping 4t268.00 4v500.00 41500.00 0.00% 32 Utilities 0.00 #DIV/01 33 Occupancy (Building & Grounds 11 160.00 91575.00 91575.00 0.00% 34 Printing & Publications 7 463.0010 000.00 1000000 0.00% 35 Subscri tion/Dues/Membershl S 11583.00 21050.00 21050.00 0.00% 36 Insurance 12 417.00 12 000.00 12 000.00 0.00% 37 Equipment: Rental & Maintenance 49284.00 41000.00 4w000.00 0.00% 38 Advertising 31247.00 33 000.00 33 000.00 0.00% 39 Equipment Purchases :Ca ital Expense 438.00 0.00 #DIV/01 40 Professional Fees (Legal, Consulting) 72 797.00 90 350.00 90 350.00 0.00% 41 Books/Educational Materials 59269.00 12 500.00 12 500.00 0.00% 42 Food & Nutrition 91387.001 0.00 #DIV/O! 43 Administrative Costs 0.00 #DIV/01 44 Audit Ek ense 4J055.00 4,000.00 41000.00 0.00% 45 Specific Assistance to Individuals 0.00 #DIV/01 46 Other/Miscellaneous 413.00 89000.00 81000.00 0.00% 47 Other/Contract 15 726.00 71726.00 7p726.00 0.00% 48 TOTAL 259 463.00 275 031 .00 275 031 .00 0.00% 49 REVENUES OVER/ UNDER EXPENDITURES -4 364.00 4v669.001 41669.00 0.00% ry'yY v r ky e z z 4 > L � r 4v d 4` �" v 7p' ,AL'9 Y .S £�x . at r i I. rrG 4� � : b f c { ... ♦ ; Cr r r 14' I. xJ 7 t {{ $ YYY af'aY d 'ry_W t - Y ' C' F. ` r r }° .£-tt° vrr fx 'gyp t k ht ^ r n`sF It ° ' t t s" ,* } .. fir 5i 1't� �`� 1 N qp} ji• s^t r . • 4 t h 1 ♦ kms . • 'S. •_ t dF. �} •_ A4 y `h I t .r t s x rt' Cr f j "ti EStb gg rr it k ` t ;�^+,. ' It, V v dgrz t. ` i +'q,. r s' f r�. t ,fl T°5 • r -4 .•�r� P. 'j ,pk' �: Cultural Cound of Indian River County Summer Cultural Camp 2004 UNIFORM GRANT APPLICATION TOTAL PROGRAM BUDGET AGENCY/PROGRAM NAME: Cultural Council of Indian River County/ Summer Cultural Cam FY 02/03 FY 03/04 FY 04105 % INCREASE FYE 09/30103 FYE 09/30/04 FYE 09/30/05 CURRENT VS. NEXT FY BUDGET A B C D ACTUAL TOTAL PROPOSED Ica, c-eo1. Sycol. a REVENUES BUDGETED BUDGETED 1 Children's Services Council-SL Lucie 0.00 #DIV/01 2 Children's Services Council-Martin 0.00 #DIV/Ol 3 Advisory Committee-Indian River 53 000.00 53 000.00 53 000.00 0.00% 4 United Way-SL Lucie County 0.00 #DIV/01 5 United Way-Martin County 0.00 #DIV/OI 6 United Way-Indian River County 0.00 #DN/01 7 Department of Children & Families 0.00 #DIV/01 a County Funds 0.00 #DIV/01 9 Contributions-Cash 71232.69 7p232.69 7t232.69 0.00% 10 Program Fees 0.00 #DIV/01 11 Fund Raising Events-Net 0.00 #DN/01 12 Sales to Public-Net 0.00 #DIV/01 13 Membership Dues 0.00 #DIV/01 14 Investment Income 0.00 #DIV/OI 15 Miscellaneous 0.00 #DIV/01 16 Legacies & Bequests 0.00 #DIV/0I 17 Funds from Other Sources 59320.0011 57320.00 52320.00 0.00% 18 Reserve Funds Used for Operating 0.00 #DIV/01 19 In-Kind Donations (Not included Intohq 91000.00 9 000.00 9000.00 0.00% 20 TOTAL 65 552.69 6555269 6555269 0.00% EXPENDITURES 21 Salaries 375.00 375.00 375.00 0.00% 22 FICA 28.69 28.69 28.69 0.00% 23 Retirement 0.00 #DIV/01 24 Life/Health 0.00 #DIV/01 25 Workers Compensation 0.00 #DIV/OI 26 Florida Unemployment 0.00 #DIV/Ol 27 Travel-Daily 41000.00 400000 400000 0.00% 25 Travel/Conferences/Training 0.00 #DIV/01 29 Office Supplies 100.00 100.00 100.00 0.00% 30 Telephone 1 140.00 114000 1 14O.00 0.00% 31 Posta e/S hipping 148.00 148.00 148.00 0.00% 32 Utilities 0.00 #DIV/01 33 Occupancy (Building & Grounds 12111 .00 17111 .00 19111 .00 0.00% 34 Printing & Publications 90.00 90.00 90.00 0.00% 35 Subscrition/Dues/Membershi s 70.00 70.00 70.00 0.00% 36 Insurance 92000.00 9 000.00 91000.00 0.00% 37 E ui ment:Rental & Maintenance 0.00 #DIV/01 38 Advertising 0.00 #DIV/01 39 Equipment Purchases:Ca ital Expense 0.00 #DIV/01 40 Professional Fees (Legal, Consulting) 22p537.00 22 537.00 22t537.00 0.00% 41 Books/Educational Materials 49750.00 41760.00 475000 0.00% 42 Food & Nutrition 0.00 #DIV/01 43 Administrative Costs 6v528.00 652800 6t528.00 0.00% 44 Audit Ex ense1 250.00 1 250.00 1 250.00 0.00% 45 Specific Assistance to Individuals 0.00 #DIV/01 46 Other/Miscellaneous 0.00 #DIV/01 47 Other/Contract 14 425.00 14 425.00 1442500 0.00% 48 TOTAL 65 552.69 65 552.69 65 552.69 0.00°yo 49 REVENUES OVER/ UNDER EXPENDITURES 0.001 0.00 0.00 #DIV/Ol q f ^� Na' � � 1 •y CSY .�W a"',1 :- i? Crf 4F� 6 iie Py . F C t44V . 2 y i r[ Y ti { a'�w°d�--, i v' 1,04ratv . - _ . .. . « ml d'i7 '-'�w�S' � � i4:h', i s�',Y+?•'� & � r ?,acT:F'w 1 t' � v ¢ ' Y+�. Cultural Council of Indian River County Summer Cultural Camp 2004 UNIFORM GRANT APPLICATION FUNDER SPECIFIC BUDGET PROGRAM EXPENSES AGENCY/PROGRAM NAME : Cultural Council of Indian River County /Summer Cultural Camp FUNDER: Children's Services -Ind . River A B C FY 04105 FY 04/05 % OF TOTAL FUNDER TOTAL VS. PROGRAM SPECIFIC FUNDER REQUEST BUDGET BUDGET col. 13/col. A) EXPENDITURES 21 Salaries 375.00 375.00 100 .00 % 22 FICA 28 .69 28 .69 99 .99% 23 Retirement 0 .00 0.00 ' #DIV/01 24 Life/Health 0 .00 0 .00 #DIV/01 25 Workers Compensation 0 .00 0 .00 #DIV/01 26 Florida Unemployment 0.00 0.00 #DIV/01 27 Travel-Dail 4, 000.00 4,000.00 100.00% 28 Travel/Conferences/Training 0.00 0 .00 #DIV/01 29 Office Supplies 100.00 80 .00 80 .000 3o Telephone 1 , 140.00 1 ,140 .00 100 .00% 31 Postage/Shipping 148 .00 148 .00 100 .00% 32 Utilities 0.00 0 .00 #DIV/01 33 Occupancy ( Building & Grounds 11111 .00 19111 .00 100 . 00% 34 Printing & Publications 90 .00 90 .00 100 .00% 35 Subscri tion/Dues/Memberships 70.00 0 .00 0.00% 36 Insurance 9 ,000.00 5,000 .00 55 . 56% 37 Equipment: Rental & Maintenance 06001 0 .00 #DIV/01 38 Advertising 0.00 0 .00 #DIV/01 39 Equipment Purchases : Ca ital Expense 0 .00 0 .00 #DIV/01 40 Professional Fees (Legal , Consulting ) 22 ,537.00 22 , 537.00 100 .00% 41 Books/Educational Materials 4,750.00 21286 .31 48 . 13 % 42 Food & Nutrition 0. 00 0.00 #DIV/01 . , 43 Administrative Costs 6 , 528 .00 0.00 0 . 00% 44 Audit Expense 11250000 1 ,250.00 100 .00% 45 Specific Assistance to Individuals 0 .00 0 .00 #DIV/01 46 Other/Miscellaneous 0 .00 0 .00 #DIV/01 47 Other/Contract 14,425.00 ; 14,425.00 100.00% 48 TOTAL" r" * ° X65 ,552.69 $52,471 .00 - 80 .04 /o K ` • • : � w tretie ijy ' r. n, ar Yt ti . .. d- 3'' '' a of , 2 :,r . J#j �,' `"q- % �Y �Fjon B4 9 � ' , ;�b, 4 d� LF F"` y, H d< " < a � i s� .a't`S v+ ��yr,; +,,rxz �•: i .�' a .y, r :44. . y ..4k - , :� yam Cultural Counal of Indian River County; Summer Cultural Camp 2004 UNIFORM GRANT APPLICATION EXPLANATION FOR VARIANCES OF 1 S% OR MORE TOTAL PROGRAM BUDGET AGENCY/PROGRAM NAME: Cultural Council of Indian River County/Summer Cultural Camp FUNDER:Children's Services Advisory Committee -Indian River County #DN/01 No explanations necessary #DN101 #DN/01 #DIV/01 #DIVIOI #DN/01 #DN/01 #DIV101 #DIVIOI #DN/0l #Dlvrol #DIVIOI #DN101 #DIVI01 #DIVI01 #DIVI01 #DIVI01 #DN/01 #DIVIOI #DN/01 #DIVI01 #DN/01 #DN/01 #DIVIOI #DIV/Ol #DN101 #DN101 c . F ppgg h f 1 YI �S .�1YL" y-jFr^aY N'Yc ° Z 3"vY' r'r "9� Y i � 4Y.j �' w x?aa!!es'" � Y y,4...+ r � ,,,, ti T's x„j.� �' ,R'_• '?wro val;Y `: SHt1/100( •�,(�. ynE i.�4N � i > > .1 x«• BO ,t4 c,�a' 8"t3 as 9qk f ! r �D �'; + f #� { Y ��' " �� c3} a4^ ? \ ° ''� � �''�� •��e�•'.ra �YJ' tir . ^m aa. y >�} i �p�,5p +, ft '.i � � "°�4�x � ,"" ?r .. � ,� .Maw �a s".> �.'� � +'x�� w•�;x �, � a �} �j� - .; Cultural Council of Indian River County, Summer Cultural Camp 2004 UNIFORM GRANT APPLICATION EXPLANATION FOR VARIANCES OF 15% OR MORE FUNDER SPECIFIC BUDGET AGENCYIPROGRAM NAME: Cultural Council of Indian River County FUNDER:Children's Services Advisory Committee -Indian River County Salaries Asking for 3% of Bookeepers time to process reimbursements FICA same as above #DIVI01 #DIVIOI #DIV/01 #DIV/01 Travel-Daily Travel Costs for 2003 were $5153 #DIVI01 Office Supplies $20 per month for 4 months =$80 Telephone $285 per month (one third cost for one line) x 4 months 7- $-1-14- -0 per year, one line of three used for program Postage/Shipping 400 pieces of mail @ .37 per piece = $148 #DIV/01 Occupancy (Building 3 Grounds Mortgage/Rent $833 per month divided by three = $277.66 per month Program uses one workstation of three for 4 months $1111 per year Printing & Publications 500 copies per month@ .03 = $15 per month x 4 months = $60; 1 Box of copy paper = $30.00 Total = $90.00 Directors/Officers Liab: $1150.00 Worman's Comp = $2450.00 Commercial/General Insurance= $4950 Student Insurance Accident $450 Total = $8987.83 #DNI01 #DfV/OI #DIVI01 Director (1 ) 518 hrs@ $16 = $8547; Creative Leaders (3) 11 Ohrs @ $15 = $4950; Art Instructors (16) @$540= $8640 Evaluator(1 ) 20 hrs @ $20 = Professional Fees (Legal, Consulting) $400 TOTAL= $22,537 Books/Educational Materials $250 per instructor x 19 (includes creative leaders) instructors = $4750.00 #DIVI01 Audit Expense Independent Audit Review 1 /3 of cost #DIV/01 #DIV/01 Supervisors 16 @ $800 = 12800; Administrative Counsleor 95 hits @$15 per hr- 1425; Recreational Counselor 20 hrs @ $10= 200 T AL = Other/Contract $14,425 ror: y 2k:K 1 i ! rtr+ t�' $E..M;' •` 's a'-,i llsf41 t � d q ° 'said dk1 �} i �Y,1s S b n t y. sy F * '1".•' �i�" k Y c!b k . F 2� = pa 9! y 1G, tiv"`*Z+N, Zane z ny 'I•�0 .,.� 1m�. .,Ky .� s,;• � I . _ ( ° A �r y _ qy ' ��y ` . ? erg r 5 ail .a syyy�� nn�,� p}Y,.�y, � 'ty. _ C^1Y'> 'LL'T£W, ✓ , S ah! T Cultural Council of Indian River County; Summer Cultural Camp; Children's Services Advisory Committee of Indian River County 2004 L BUDGET FORMS 14-21 X Budget Narrative Worksheet , . . . . . . . . . . . . . . 14- 16 XTotal Agency Budget . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 . . . . . . . . . . 17 X Total Program Budgets . . , 1 . 1 1 1 1 1 1 . . . . . . . . 1 . 1 . 11 , 1110 & . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . 18 X Funder Specific Budget . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 000 * 04, 00 # 41 , . . . . . . . 19 X" Total Program Budget Variances . . . . . . . . . . . . . . . . . . . . . . . 1111 . . . . . . . . , . . . . . . . . . . . . . . . . . . . . . 20 X Funder Specific Budget Variances , ' @ * . , a 0 * 0 gas I ' l l , . . . . 21 X J. FUNDER SPECIFIC/ADDITIONAL SHEETS 22-26 X Not for Profit Agency Certification . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . : . . . . : . . . . 22 X Authorization for Release of Information . . . . . . . . . . . . . . . . . . gas " I . . . . . . . . . . . . . . . . . . . . . . . . . 23 X Sworn Statement/Nepotism Statement . . . . . " glass , . . . . . . . . . . . . . . . . . . . . . . 0 0 . 0 . . . . . . . 6 . . . . . 24-26 K. APPENDIX X List of Current Board of Directors . . . . . . . : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 X Audit Report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I . . . . - - . - - . . . . . . . . lass . . . . . . . . - . . . . . . . . . . . . . . 28 37 X Management Letter , a I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . " I " I ' ll " I " I 1 . , 38 -40 XIRS Form 990 , 11 " 1 . . . . . . . . . 1 " I11 . . . . . . ' " I * * * 00 ' . . ' 4090 * . . . . . . . . . . . . . " aagoI . , " II . , allal . . . . 41 -61 X Most Recent Financial Statement (Profit & Loss) , . . . . . . . . . . . . . . . . . . . . 62 Xllllll Operating Budget , , I I I I . . . . . 1111906060 00 6 . 0 0 gas . . . . . . . . . . . . . . . I ' ll . , " I " . . . 11 . 11 . . . . . , 1111 63 X Balance Sheet , , , , , , , , , " , ll . . * 9 so * ago ' * @ . . a " 1 64 Xl_ool Staff Organizational Chart , . . . . . " I " I " 16 , 0 . . . . . . . . . . . . . . . . . . " I ' ll " I " I " I ' ll " " . . . . glass 65 Xllllll Most Recent Annual Report (not available) XIlllll 501 (c) (3 ) IRS Exemption , . , , . , . , , " , " , * * , 0 . . . . . . . . . . . . : . . . . . . . . . . . . . . . . : . . . . . . . . . . . : . . . . . 66-67 Xllllll Articles of Incorporation , , . . . . . . . . . . " I ' ll . . . . . . 68 -72 XAgency' s ByLaws . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73 -79 X Agency' s Written Policy Regarding Affirmative Action. . . . . . " I " I " I gas & a * . . * 9 . . , . . . , 80 llllosX Nepotism Statement , . . . . . . . . . . . " I ' ll . . . . 01 " I ' . . googol . . . . 000 * 0 . 1 " 1 " I ' llI ' ll , . . . . . . . . 81 N Apl . c ?y1 � •_ " .'r ° �'"t'$afi r) a Cr 'ba '43 � d , � '"`a`�y. .,Ile df I � S ♦ L� � d.1L IN 1 ♦ i✓ �i IL 1 'yq K . C . f ty'xACn' ,54Ii s .fit y. - _ .h. . . ♦ 4Sh , �a a 'H?aW�"i ' t'�"` .. `Y '. + .�}' . . , o. ^,tv_la�3 a '� � .}�� ,. ��r�R Y.'- 4�1. Cultural Council of Indian River County; Summer Cultural Camp; Children's Services Advisory Committee of Indian River County 2004 ORGANIZATION : Cultural Council of Indian River County PROGRAM : Summer Cultural Camp TABLE OF CONTENTS Please 'X" the parts of the grant application to indicate that they a a included. Also, please put the page number where the information can be located. Section of the Proposal Pa e # X TABLE OF CONTENTS (checklist) , , , " , ' , , . . . . . . . . . 1 -2 X COVER PAGE (with signatures) . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . 3 A. ORGANIZATION CAPABILITY (one page maximum) X 1 . Mission and Vision of organization. . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 X 2 . Summary of expertise, accomplishments, and population served . . . . . . . . . . . . .. . . 4 B. PROGRAM NEED STATEMENT (one page maximum) X 1 . Program Need Statement , . . . . . . . 5 X 2 . Programs that address need and gaps in service , . . . . . . . . . . . . . . . . . . . . 5 C. PROGRAM DESCRIPTION (two pages maximum) X 1 . Funding priority . , , , , I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1111 . . ; . . X 2 . Description of program activities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . : . . 6 X 3 . Evidence that program strategy will work. . . . , 6 X 4 . Staffing , , , , , " I " I " I " I . , . gage * 6 , 0006 446 . 1 . . . . . . . . . . . . . X 5 . Awareness of program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . a . . . . . . . . . . . . . . . . . . . . . . . . . . 7 X 6 . Accessibility of program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 X D . MEASURABLE OUTCOMES (two pages maximum) . . . . . . . . . . . . . . . . . . . . . . . . 8 -9 X E. COLLABORATION (one page maximum) . . . . . . . . . . . . . , 1111 10 F. PROGRAM EVALUATION (two pages maximum) X 1 . Demographics. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 . 1 . 1 . . . . . . . . . . . . . . . . . . . . . . . 1111 . . . . . . . . . 11 X 2 . Measures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 11 X 3 . Reporting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 X G. TIMETABLE (one page maximum) . . . 12 H. UNDUPLICATED CLIENT COUNT X 1 . Projections by Location . . . . . . . . . . . . . . . . . . . . . . . . . . . " I . " " I " I ' ll " I " 1 13 X 2 . Projections by Age Group . . . . . . . . . 16 0 . 0 0 . 0000 @ease , 13 4�J y Ti l - ; MIT ,i xy .M .9^p § ;• P 2.. 4 [' Y z x "�4w� z �+ca • rt . . A S, s _ s r �{ r 's > �y Ay} �^�y .k 1� I 2 . t s I •' �. e '' � W �{ o Y'b 't c v 1 1 � t � _ .. ♦ t�� y n. a �--�1s 1 � S � '. + � i 1i � 'a � r ��q MtIhh "t .t, '£k !?AawSk� 5 S G '.' � y� v ♦ e{J i3' A l 3 ,yS.. (�*3,-y� ' �eMrF . .f" vAr OCT - 29 - 2ee4 ee : 54 AM CULTURAL . COUf4C'f IRC 7T27T034e3 , Internal Revenue Service Department of the Treasury P . 0 . Box 2508 Cincinnati , OH 45201 Date : February 15 , 2000, Person to Contact: Vicki Adams 31 -04011 Customer Service Representative Cultural Council of Indian River County, Inc . Toil Free Telephone Number : 2145 141" Ave . Ste , 1 .1 877- 829 -5500 Vero Beach , FL 32960-4413Fax Number : 513-263 -3756 Federal Identification Number: 59-3299133 Dear Sir or Madam : This letter is in response to our receiving your correspondence concerning your Advanced lRul ng period which has been satisfied . Our records have been changed to reflect this . This letter will take the place of the copy you requested , Our records indicate that a determination letter issued in February 1996 granted your organization exemption from federal income tax under section 501 (c) (3) of the Internal Revenue Code . That letter is still in effect. Based on information subsequently submitted , we classified your organization as one that Is not a private foundation within the meaning of section 509(a) of the Code because It is an organization described in section 509 (x)(2) . This classification was based on the assumption that your organization's operations would continue as stated in the application . If your organization's sources of support, or its character, method of operations , or purposes have changed , please let us know so we can consider the effect of the change on the exempt status and foundation status of your organization . Your organization is required to file Form 990 , Return of Organization Exempt from Income Tax, only if its gross receipts each year are normally more than $ 25 ,000. if a return is required , it must be filled by the 15th day of the fifth month after the end of the organization's annual .accounting . period . The law imposes a penalty of $20 a day, up to a maximum of $ 10, 000 , when a return is filed late , unless there is reasonable cause for the delay. . All exempt organizations (unless specifically excluded) are liable for taxes under the Federal insurance Contributions Act (social security taxes) on remuneration of $ 100 or more paid to each employee during a calendar year. Your organization is not liable for the tax imposed under the f= ederal Unemployment Tax Act (FUTA) . Organizations that are not private foundations are not subject to the excise taxes under Chapter 42 of the Code . However , these organizations are not automatically exempt from other federal excise taxes . Dono -s may deduct contributions to your organization as provided in section 170 of the Code . Bequests , Legacies , devises , transfers , or gifts to your organization or for its use are deductible for federal estate and gift tax purposes If they meet the applicable provisions of sections 2055 , 2106 , and 2. 522 of the Code . mA4 . �{ OCT - 29 - 2004 08 : 55 AM CULTURAL . COUNC'TL ` T'RCk> .r . ' Y 7727703403 P . 92 1 _2. Cultural Council of .lndian River County Inc. 59 - 3299133 Your organization is not required to file federal income tax returns unless it is subject to the tax on unrelated business income under section 511 of the Code , If your organization is subject to this tax, It must file an income tax return on the Form 990-T, Exempt Organization Business Income Tax Return, In this letter, we are not determinog whether any of your organization's present or proposed activities are unrelated trade or business as defined in section 513 of the Code , The law requires you to make your organization's annual return available for public inspection Without charge for three years after the due date of the return . You are also required to make available for public inspection a copy of your organization ' s exemption application , any supporting documents and the exemption letter to any Individual who requests such documents in person or in writing, You can charge only a reasonable fee for reproduction and actual po :;tage costs for the copied materials . The law does not require you to provide copies of pubec Inspection documents that are widely available , such as by posting them on the Internet (World Wide Web) . You may be liable for a penalty of $20 a day for each day you do not make these documents available for public inspection (up to a maximum of $ 10, 000 In the case of an annual return) . Because this letter could help resolve any questions about your organization's exempt status aid foundation status, you should keep it with the organization's permanent records , . If you have any questions , please callus at the telephone number shown in the heading of this letter, This letter affirms your organization's exempt status , Sincerely, Robert C , Padilla Manager, Customer Service EXHIBIT B [From policy adopted by Indian River County Board Of County Commissioners on Feb uary 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 �eported 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 waawarded . 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 301h) 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 . Th se 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 ane ployee ) , 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 : : Cultural Council of Indian River County Courthouse Executive Center 214514 th Avenue - Suite 11 Vero Beach , Florida 32960 Attention : Mary Jayne Kelly 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 relatingto 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. Cultural Council oflndianRiver County Web site : www _cultural-council . ora E-mail : info@cultural - council . org Chairman Sheila Tucker Vice Chairman Richard Stark Treasurer October 18 , 2004 Janice Broda Secretary Attn : Risk Manager, Indian River County Ellen Fischer 1840 25a' Street Vero Beach, Florida 32960-3365 Board Ray Adams Dear Ms . Jordan, Nancy Bryant Jafar Falasiri Barbara Ferrell Please be advised that the Cultural Council of Indian River County does not own , Peter Ford rent or lease any vehicles and therefore, the additional insurance requirement Dorothy Hudson pertaining to such equipment does not apply to our program . Mary Knapp Marcia Loewinger Thank you for your attention to this matter . Barbara Miller Robert L. Richardson Margaret Segal Sincerely, Robert L. Temple Commissioner Ken Ma ?vv Markrk Wygonik Mary Jayne Kelly Cultural Advisory Executive Director Chairman Susan Smith Executive Director Mary Jayne Kelly Courthouse Executive Center ♦ 2145 14`" Avenue, Suite 11 ♦ Vero Beach, L 32960 Phone: (772) 770-4857 ♦ Fax: (772) 770-3403 This program is sponsored in part by the State of Florida, Department of State, Division of Cultural Affairs, and the Florida Arts Council lli 17 / LUU4 id;oZ kA.L i7 & 509 wJ4b0 Jlll DAINAGh 1AZor C. uuli Uul DATE (MM/OD/YYYY) TM. ACCO CERTIFICATE OF LIABILITY INSURANCE NOV 1704 PROCUGFR THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION SID BANACK INSJA HILB ROGAL & HOBBS CO. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 204514TH AVE. HOLDER- THIS CERTIFICATE DOES NOT AMEND, EXTEND OR P 0 BOX 130 ALTER THE COVERAGE AFFORDED RY THS POUCIES BELOW. VERO BEACH FL 32961 INSURERS AFFORDING COVERAGE I NAIC # INSURED II NSURER A: ESSEX INSURANCE COMPANY j CVLTURAL COUNCIL OF INDIAN RIVER COUNTY, INC . IINSURER B: HARBOR SPECIALTY INSURANCE CO _ I_ 214514TH AV #11 ' INSURER. CP _ � y VERO BEACH FL 32960 --D, - - - INSURER P. I 1INSURER 9; COVERAGE$ THE POLICIES OF INSURANCE LISTED BELOW HAVE DEEM ISSUED To THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING ANY RFOUIREMENT, TERM OR CONDITION OF ANY CONYRAOT OR OTHER DOCVAENT WITH RESFECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBEU HEREIN IS SUBJECT TO ALL THE TCRMS, EXCLUSIONS AND CONDITIONS OF SUCH r0LIC!ES. AGGREGATE LIMITS SHOWN MY HAVE BEEN REDUCED BY PAID CLAIMS. NSR AD" TYPE OF INSURANCE POLICY NUMBER POLICY ESFECTNE T►OUCY EEPIRA710f1 I � '� LIDUTS LTR INBRD DATE MNM DATE NWT)D ' GENERAL LIABILITY 3CM8192 MAR 10 04 MAR 10 05 EACH occuPJRENCE ', i 1 , 000,000 ^ NAGE TO Ie:NfEO I X COMMERCIAL GENERAL LIAEILIITI Allm} . . 3 SO,000 ___ .. _ —_ _oo !—� ----, I MED. EXP An or*CLIAIMS MAOEJ X OCCUR ( y parson, g MOO A ! ! -I PERSONAL a ADV INJURY I s 100000000 j� I GENERAL AGGREGATE is 200001000 GEN'L AGGREGATE LIMIT APPLIES PER I ' PRODUCTS•CQMPtQP AGG S 100000000 I POLICY F71 FRO ECT I i LOC —I- - - - AUTOMOBILE LW9IUTY COMBINED SINGLE LIMIT T"TTTI ANYAUTCI (Essocldenq 1 I I ALL QkVNED ALTOS i I BODILY INJURY SCHEDULED AUTOS )PerpW50n) � S { 1 HIREDAJTOS I BODILY INJURY I NON•OWNEDAUTOS i *Per sooldenl)i _ I . _Y. . , PROPERTY DAIMGE s (Fey secldenP I GARAGELIALYLITYi IAU70ONLY - EAACCIDENT ANY AUTO OTHER THAN lEA ACCO s _ - _ I ( AUTO ONLY. S EXCESS 1 UMBRELIJ� LUIBILIT�' y I EACH OCCURRENCE j$ —� OCCUR U C:AIMS MADE l I I AGGREGATE IS I CEDUCTIBLE RETENTION 6 I I s 'WORKERS COMPENSATION AND 099000004981203 DEC 20 03 DEC 20 04 � " 4 si0� Tey, I { ° R ! EMPLOYERS LIAEILITY I I ! E L EACH ACC 'DENT TS _ 100 , 000 B I ANY PROPRIETO"ARmexlExcauTIVE I 1 •� ' OFFICER.MEMbER ERC:UDEDT I I I E. L. OISEASL.EA EMPLOYEE jlhrs, tlrscdWufrler � I ; SF[pALPNOVIBaMesolor IE.L. DISEASE•POLICYLaNT IS 5004000 OTHER: DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS CERTIFICATE HOLDER IS NAMED AS AN ADDITIONAL INSURED WITH RESPECT TO GENERAL. LIABILITY, CERTIFICATE HOLDER — CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE bDCPPAT, ION DATE THEREOF. THE ISSUING COMPANY WILL ENDEAVOR TO MAIL ' 0 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. BUT FA'LURE TO DO 80 SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KING UPON THE INDIAN RIVER COUNTY INSURER, ITS AGENTS OR ACPRBSENTATIVES 1940 26TH STREET AUTHORIZED REPRESENTATIVE VERO BEACH, FL 32960 Attention , HUMAN SERVICES-FAX: 971 1795 gu . Thi ACORD 25 ( 2001 /+08 ) Certif calla # 62240 O ACORD CORPORATION 1988 NOV - 11 - 2004 10 : 33 AM CULrURAL . COUNC ] L . IRC 77277OX403 P903 7 WORMS COMPENSATION AND 3MPLGYERS _ IABILITY INSURANCE POLICY WC 99 05 01 A REISSUE INFORMATION PAGE RENEWAL AGREEMENT Insurer ; Producer : Agpntd 422 Harbor Specia _ ty Insurance Company Sid Barrack Insurance C / O Unisource Administrators , I . >?,0 , Box 130 5951 Cattleridge Blvd . , Suite 2CO Vero Beach , FL 32961 Serasota , FL 34232 ( Carrier Code : 35270 ) 024 Ca :• _• '_ er Policy l : 0 ) 9000004981203 Cer ' ier Pr '_ ar Poli : y # : 099000004981. 202 1 . The Insured : Cultural Co : r. cil of rndian River Co :; nty , Type of Business Corporation Mailing Address : 2145 14 Ave X11 Vero Beac :n , �zI. 32950 • Other vrkplaces not shown above : Fein : 593299 33 NO OTHER CORK ?LACE $ FOR ^. HIS PC- LICY Risk ID ; 2 . The nolicy period is from 12 : 01 t . m , on 12 / 20 / 2003 to 12 : 01 a . m . on 12420/ 2004 a - the ins •ared ' s mailing aedress . 3 . a . Workers Compensation Insurance Part One of the pClicy applies - n ; hs tvor. kers Compensation law of the states listed here : FL B . Tmployers Liability. Ir, Fur % ncCj : Pa _' t Two of _ }? e policy app _ ies to he rk in each state listed in Item 3 . A . The lira of o =*- IA. abi, lity under Part Two are : Bcodily Injury by Accident $ 1 . 0 , 000 each accident Bodily Injury by Disease $ i 500 , 000 policy limi _ Bodily Injury by Disease $_ _ 100 . 000 each employc-e C . other States Insurance : D . This poli , y in.c _ udes these endorsemert .i a " d :Zhedules : WC000000A ( 04 / 92 ) WC000414 ( 07 / 90 )) W000 (142G . 442 ' 02 ) WC090606 ( 10 / 98 ) 4 . ? he premium for this policy will bt. dete .rmirn?d bY our Manuals cf Rulfs , ' Classifications , Rates and Rating fllaIls . Al '. inlCrm --- ' on required below is subject to vftrifi, cation and change by audll . Classifice . _ ons . Code Premium :lasis Rate ? el' Estimated NO _e"' tal Estinated $ 1010 of Annual F -inual Remuncration Remuneration ! Premium SEE SCHEDULE OF O ' ERAT.IONSILI r, M RR T`0ta : ?. stimated Annual Prem "_ um $ 2 , 38 . 00 .� a t . ,6 :3 Minimum Prc.. m `_ um S 50 . 00 E>: pensr-_ mon :; tant S 200 . 00 r WC 99 6 01 A co t - :. . F a b s