Loading...
HomeMy WebLinkAbout2004-229R I 0 le R1Gl 0 Indian River County Grant Contract This Grant Contract ("Contract") entered into effective this 1st day of October 2004 by and between Indian River County, a political subdivision of the State of Florida , 1840 25th Street, Vero Beach FL , 32960 ("County") and Cultural Council of Indian River County, (" Recipient") ; of: Cultural Council of Indian River Courthouse Executive Center 214514 th Avenue - Suite 11 Vero Beach , Florida 32960 After School Arts 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- Five Thousand Dollars ($35 , 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 , 20041 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 - f , (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: Q Arthur R . Neu erger , C airman Of BCC Approved : Attest : J . K. Barton , Clerk Deputy Clerk Approved : ' ` Jos h' A ,43aird County Adr`r Fh!0 grq :, Appro as to rm and legal sufficiency: aria . F ssistant ey 3 RECIPIENT: c?&� CULTURAL COUNCIL OF INDIAN RIVER COUNTY - 4 - EXHIBIT A [Copy of complete proposal/application] - 1 - Cultural Council of Indian River County, After School Scholarship Program; Children's Services Advisory Committee of Indian River County PROGRAM COVER PAGE a izati o xecutive hector: Mary Jayne Kelly Email : mjkelly@cultural-council. org Address : 2145 140i 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 le Avenue Suite 11 Telephone : (772) 770-4857 Vero Beach_ Florida 32960 Fax: (772) 770-3403 e eop Priority Need Area Addressed: Me'ntJWeI ness care Access Brief Description of the Program: The After School Arts Program has been in operation for five years and has had a substantial impact on many youth Indian River County Classes are held after school or on Saturday mornings in Artists ' studios classrooms or community centers In addition we are offering an instructor at independent after school Drop, anticipating more children can be served by bringing the classes to where they already are At the end of the year, students perform at the Children' s Art Festival and exhibit their art in the Carolyn Eggert Children ' s Gallery at the Vero Beach Museum of Art. Taxonomy Codes : RB 150, RB 180 • RB 183 , RB 500 , RB 660 S.UMMAR _ RE . OR — Ente Information In The Blacl�_Cells„Onl _ - .4�, . 'z X00 �.Q2.� Total Proposed Program Budget for 2004 /05 : $ 52 , 576 . 00 Percent of Total Program Budget : 66 . 6 % Current Program Funding ( 2003 /04 ) : $ 35 , 000 Dollar increase/ ( decrease ) in request : $ - Percent increase /( decrease ) in request * * : 0 . 0 % Unduplicated Number of Children to be served Individually : 6 Unduplicated Number of Adults to be served Individually : - Unduplicated Number to be served via Group settings : 117 Total Program Cost per Client : 1 427 . 45 * *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 , 2004 Sheila B . Tucker n i t ' C: Name of President/Chair of the Board Signature Mary Jame Kelly yName of Executive Director/CEO t Signature A . ' "yT= I,. Cultural Council of Indian River County; After School Scholarship Program; Children's Services Advisory Committee of Indian River County 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 65 children per school year and the summer camp has served over 230 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 e olve for two purposes : to expose more children and teens to the arts and to nurture those students that exhibit exceptional tarent . 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. 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, d ry � mt t "4` .V � V 4e a + Cultural Council of Indian River County, After School Scholarship Program; Children's Services Advisory Committee of Indian River County 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 the same report, for service that we provide for 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) Boys & Girls Clubs, Indian River County Recreation Department, Recreation Department of Vero Beach, Gifford Youth Activities. Center, Dasie Bridgewater Hope Center, Youth Guidance Volunteer Program, Hiz Kidz. b) In conversations with these entities, it was revealed that arts instruction was viewed as a desirable component but basic needs had to be met first. By the time basic needs are met, funds are scarce for including arts instruction. All acknowledged that arts instruction would enhance the program and the children' s experience in after school activities . Some organizations have volunteers that come and provide intermittent services, but not consistently. Consistency and dependability are the cornerstones of providing children with an environment that promotes mental wellness . .u- 5 at f\ yry* t f� -4 .o Via&c k% 7. d L { h _t 1 Al yz• �..'ttr `l ^�c � +.4 hz . ��'� '- x . s . . . . ' „v ,5��- .}ti`f . u, ,�{"�' Cultural Council of Indian River County, After School Scholarship Program; Children's Services Advisory Committee of Indian River County C. PROGRAM DESCRIPTION (Entire Section C, 1 — 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 7- 17 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 tools to help them succeed to adulthood in a safe, healthy and productive manner. This program offers , creative classes in music, visual and performance arts in a variety of settings. Instructors for these classes are professional artists in the community that want to share their love of their craft with young people. Eligible children have an interest in the arts, participate in the free or reduced lunch program and/or have been referred to the program through their school. Some classes take place in schools, some in artist studios and others at community centers . Children placed in after school programs such as Gifford Youth Activities Center, Boys & Girls Clubs and Dasie Bridgewater Hope Center have the opportunity to participate in these classes at their sites as well. The Teen Writer' s Workshops, held quarterly, also attract young people in off school hours, engaging them in productive activity at the Environmental Learning Center. 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: Visual 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 luw 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 Matter for 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 backgrounds. (UCLA Imagination Project, Americans . ' for the Arts, ' 198) By providingfiarts opportunities and choices ata young age, luldren become motivated" arid en a ed in* this" health outlet for expression. , �• Mho .iSNf"� ' , .. H `9Yln } � ..•. Y '4 - eF�T ry i46 Cultural Council of Indian River County; After School Scholarship Program; Children's Services Advisory Committee of Indian River County 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). Program 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 10 hours per week. Arts Instructors : Provides weekly lessons in a specific discipline such as sculpture, piano, voice, painting. Assists with administering evaluations, required documentation and reports . Determines need for supplies and materials within the budgetary guidelines . Responsible to Program Director and to keep the Cultural Council informed of any concerns or changes in their schedules . Assists with year end display and participation in the Children' s Art Festival . Required : Experience teaching art to children, experience with a specific artistic skill. Contracted Position for 1 . 5 Hours per week. Program Evaluator: 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 40 Hours Total. Bookkeeper: 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) 5. How will the target population be made aware of the program? The targeted population will be made aware of the program in several ways . First, students currently enrolled in the program that have a desire and motivation to continue will be allowed to do so . Students that attend the Summer Cultural Camp will be made aware of the availability of the program. Schools Support Specialists will receh e a memo in the Fall explaining the program and in what locations classes are available. All collaborative partners will receive memos explaining the program and what instructors are available for their site, so they can select what works best for their group . 6. How will the program be accessible to target population (Le" location , transportation , hours of operation) ? The program is accessible to the target population at sites that are located throughout the County. Children will either take a bus to their location and parents/guardians will pick them up, or parents/guardians provide transportation. Classes take place immediately after school or on Saturday Mornings. - p� Til Ol v illt Y w a .fie. f 3 4. , .,w f';' v1wA *41¢,..5 S i;'Sy •i • / J fiY9 ' t M ffp �3s^ a � 94I VA Cultural Council of Indian River County, After School Scholarship Program; Children's Services Advisory Committee of Indian Riva County D. MEASURABLE OUTCOMES OUTCOMES ACTIVITIES Add all of the elements or the Measurable Outcome (s) Add the tasks to accomplish the Outcome(s) 1 , 1 . 1 : To increase the number of children served in Cpntact all independent after school programs after school arts classes or field trips for to assess interest and scheduling of arts classes children enrolled in independent after school and/or field trips. programs by 10% in one funding year as reported by the after school program records. 1 . 2 : Baseline: 2003 —2004 funding year records of Document 2003 —2004 funding year arts arts classes or field trips in independent after classes and field trips from program records . school programs . 1 . 3 : Maintain records of arts classes and field trips for 2004 —2005 funding year for each participating program. 1 . 4 : Compare records of 2003 —2004 to 2004 — 2005 . 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 2 • � •, ,�� 5y q,e 'L ; M1' t r -s+eU naF i r Sir i "M1' �, FFv+t ..' M ;Y' . •,-t* Y'- - rt ; ,x u r 41 8 s g �,,.yy� 1. n Cultural Council of Indian River County; After School Scholarship Program; Children's Services Advisory Committee of Indian River County 3 , 3 . 1 : To retain students already enrolled in the. After Identify returning students enrolled in the After School Arts Program by 60% in one funding School Arts Program. year as indicated by the 2003 — 2004 funding year records. 1 3 . 2 : Baseline: 2003 — 2004 List of students for the Identify returning students that complete the after school program. program for the 2004 — 2005 funding year. 3 . 3 : Compare the beginning and end of year names to determine retention, it It ;It d Q i,JwdkYb i Ji . } } 414 tv . . kx �% Cultural Council of Indian River County, After School Scholarship Program; Children's Services Advisory Committee of Indian River County E. COLLABORATION Entire Section E net 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 Gifford Youth Activities Center Facilities for instruction Ongoing communication & assessment Participation in evaluation Boy' s & Girls Clubs Facilities for instruction Ongoing communication & assessment Participation in evaluation Dasie Bridgewater Hope Center Facilities for instruction Ongoing communication & assessment Partici ation in evaluation Indian River County School District Facilities for instruction Ongoing communication & assessment Assistance with transportation Laura Riding Jackson Foundation Facilities for instruction Instructors Ongoing communication & assessment Participation in evaluation Academy for the Performing Arts Instructors Ongoing communication & assessment Participation in evaluation Indian River County Charter High Facilities for instruction School of Visual and Performing Arts Ongoing communication & assessment Participation in evaluation r c ✓aY _ . •1 p Iv F 1 1 QAC' i aPI . N4?-. c `^ ♦ roR7i>.?' ' �'� . . ` j .._ _ _ _ , _ .._.-.__�.y.. .moi;.+. e, . , � 1Q e'er w" 1f ' lr IFi 1 1 iG y� � .. ?If 1 xYy� m 11' Cultural Council of Indian River County; After School Scholarship Program; Children's Services Advisory Committee of Indian River County F. PROGRAM EVALUATION (Entire Section F not to exceed two pages) 1 . DEMOGRAPHICS : What information (data elements) will you need to collect in order to accurately describe your target population including demographics (age, gender, and ethnic background) required by the funder in Section H? What are the pieces of information that qualify them for your target population ? How do you document their need for services or their "unacceptable condition requiring change" from Section B19 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 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 ? • Referral Form for use by Instructors, Teachers and Student Support Specialists. • Information Sheet for Participating After School Programs • Database of participating students, including demographic information and indicated risk factors. • Records of arts classes and field trips held at participating independent after school programs, for baseline information and reporting information. • Silver Drawing Test of Cognition and Emotion: This test measures self-concept and provides visual indicators of risk factors. A Registered Art Therapist, with a Masters Level Education, scores the test. • Data collection and refinement will be ongoing , 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 . Children that have additional risk factors indicated by the Silver Drawing Test will be identified and those children' s parents/guardians mill. be, contacted . A final report will be shared with the funder and the community, will have accesys to . the results. The Silver Drawing Test results will be pooled with the researcher' s national data�All final reports are o en to the public for review., .;, �$, rkrv'• y F i 2.�,. Saw. : wr w s y . ' Cr..e j� .^v €1 -: y {f; ^ c3J K R Y 4 y ' ^T �G�Y. ��• ��`�$ i� A __'_"`.'ry#'_"'. a�Yh� � r }.� �ht. . ^z�--4–^.—+r .+: ell1 'x{.{t%,'a i'hxi", y`1 "Ery tti +. nj rz 1 1 �y4..y'�'�t✓ ej� r +}+e s p Y .�.�E`Z 'inw { 3,t","` -. �4,k .A# '� m > a41 13 •1 I'y'4 r Yi +Tn1 4 df6e 9. • - Y!a F {1 'Tf �l - • p -Q •, . ` � r- -G'i,�Fi4 i ? �- �9'i . �' ., S4�sF' .. s ! ' <"` ,.. •wY e�ai*` `+ . ' . . T`=F��`: f: l. . ,. �,f. ktt` F Cultural Council of Indian River County; After School Scholarship Program; Children's Services Advisory Committee of Indian River County G. TIMETABLE (Section G not to exceed one page) 1 . List the major action steps , activities, or cycles of events that will occur within the program year. New programs should include any start-up planning that may occur outside the funding year. In completing the timetable, review information detailed in prior sections. Month/Period Activities October 2004 • Contact all independent after school programs to assess interest and scheduling of arts classes and/or field trips . • Assemble referrals from schools, returning students and cultural camp attendees. • Document 2003 —2004 funding year arts classes and field trips from Participating :ndependent after school program records . • Match students with appropriate sites and classes . • Set up records of arts classes and field trips for 2004 —2005 funding year for each participating program. November 2004 . Administer Silver Drawing Test as pre-test to participants in program in the first month of program being operational • Identify returning students enrolled in the After School Arts Program, October 2004 — . Conduct classes and field trips . May 2005 Administer Silver Drawing Test as post-test to participants in the last month of program being operational. May 2005 • Program classes cease • Compare arts class3s and field trip records of 2003 —2004 to 2004 — 2005 , • 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 ' June 2005 • Identify returning students that complete the program for the 2004 — 2005 funding year. • Compare the beginning and end of year names to determine retention. July 2005 • Prepare Final Report r $t SFJ k g- I_T iL+ d s nhat . . ,..•.: , ' ..,Y",n.5,y +iy ,5i "�` £ �F'£eJ � A � �' t. __ ____--'�-•__..r.. ._..e-.. . _`_"_"""^"""'1" < r ,, ` � 2 _ Cultural Council of Indian Rivet County-, After School Scholarship Program, Children's Services Advisory Committee of Indian River County H. PROJECTIONS FOR UNDUPLICATED CLIENTS Number of Unduplicated Clients by Location o :<:: < v . , , ,:}• • C 'rrent Fiscal Year .01 , Location > �:: ::-. . .> Budget 2003 04 >:;>::.::.> :::: :::::>::<v . .- Unduplicated Clients Unduplicated Clients Unduplicated Clients N. Indian River County 13 25 58 S . Indian River County 44 60 65 Indian River Co. Total 57 85 123 Greater Stuart - - - Hobe Sound - - - Indiantomn - - - Jensen Beach - - - Palm City - - - Martin County Total - - - Fort Pierce - - - Port Saint Lucie - - - St. Lucie Co. Total - - - Other Locations - - - TOTAL SERVED 57 85 123 Number of Unduplicated Clients by Age Y r Current FiscalYear Location Budget 2003/04 P Individuals Group 'd d €a {;:+iJ:v: :{{jJ:y-w•"i. {;r{rij::j{j :i 0 to 4 - (Pre- school) - 5 to 10 - (Elementary) 22 3 26 3 26 11 to 14 - (Middle) 35 - 3 53 3 91 15 to 18 - (High School) - - - - - - Total Children 57 - 6 79 6 117 19 to 59 - (Adults) - - - - - - 60 + (Seniors) - - - - - - Total Adults - - - - - - TOTAL SERVED 57 - 6 79 6 117 � � '- S� i �',YR 141 3 a.i t .Y _ �:�h u•+ - '� v W r W � x4 Ia.1rF N a Xk � t ♦ . �^ 7 fM P t P M ,gam 1;."✓`,-�V Fi_.�. ._.- rM `V• 13 r LL* . % .5 r:c: ;y., '� . " 'r , . ? 4 ..'� .b +•,.�! c,'`+§+�`w .$�t: ,. •CuftwW Council of Indian River County After School Arts Program 2004 UNIFORM GRANT APPLICATION BUDGET NARRATIVE WORKSHEET AGENCY/PROGRAM NAME: Cultural Council of Indian River County/After School Arts FUNDER: Children's Services Advisory Committee - Indian River County tt MINION 1 Children's Services Councl"t. Lucie 2 Children's Services Council-Martin 3 Advisory Committee4ndian River 35 000.00 35 000.0 88,ODO.00 4 United Way-SL Lucie County 5 United Way-Martin County 6 United Way-Indian River County _ 7 Department of Children d Families 6 County Funds _. 133,400.00 9 Contributions-Cash :, 5,700.00 10 Program Fees 11 Fund Raising Events-Net 33,500, 12 Sales to Public - Net 13 Membership Dues 10,000. 14 Investment Income - 16 Miscellaneous _ - 1 ,100. 16 Legacies 3 Bequests 17 Funds from Other Sources - 7,0D0.00 9,000. 16 Reserve Funds Used for Operatin - 19 In-Kind Donations (Noe Ireduded In War) 10 576.00 20 TOTAL REVENUES (down Include IIn• 79 $42,000.00 $150000 $279,700.01 EXP RE .os = etf7oteG n ` WF a:ioa I undefwSc111c $uryet ' of 21 Salaries - (must complete chart on next page) rntor of 375.00 375.0 $9,490.00 22 FICA - Total salaries x 0.0765 6 28.69 28.6 4,550.00 23 Retirement - Annual pension for ua5fied staff _ 0.0 24 Life/Health - Medical/Dental/Short-tern Disab. 0.0 26 Workers Compensation - # em to ees x rate - 0.0 Florida Unemployment - # proJeded employees 26 $7,000 x UCT-6 rate 0.0 -Rl ES- Executive Director 47,000.00 0.00 0.0 0• Executive Assistant 12,480.001 375.00 375.0 3.00 #ON/Ot #DN/01 #DN/01 #DN/01 #DN/01 #DIV/01 #DN/01 #DN/01 #DN/01 #0N/01 #DN/01 #DN/01 #DN/01 Porviot #DN/01 #DN/01 ' ccs, r e z qn,'. : •ei . . _ _ . . , 'AN T. #ON/01 x RemainMa pos ns thyroughoutthe e ^� P : f aw x«•g5,aszu,#aS•Sa>t`t Total SafadesJ04W"�*P, $59,480. 37500 ` "' "' ` 3750 =-`L'" °+'ri'",',-' 063 1,`_'.'.:_ ..•� ! t �yi 4 { R ,�.y..,. .-. ±� ._'�_ _.�..,,nr.-.y.,.,. d' - 1 �i ' c 84 $Isco01 n t t*"i"k,¢ .ay. r vS;4 ,F * 3 y °.1..t`„z ' ti I 7 r_ .'r t• V� r, tk' e s 'kµ� t T tt a: L4{ . yy > - a�rrt .- �+iiv w a .a ,� +� ��`ynrV - '�. . ',56`_,#ka'*K�} ' �. w "�. . , 4• . `: is, r tt''p K4..:: 4$'±- �' n ° •'t�F''•a-4 ?.4, 4 h[.l�.r> :'u"�''",'n �i�. + R i+'. ° 4, '1" , '? :"f . `. 7`': . Cultural Council of Indian River County Ma School Arts Program 2004 wm s Executive Director O.Oil 0.001 0. Executive Assistant 375. 28.59 28.691 0 0• 0.00 0.001 0 0.001 0.00 0.04 0 0.01 0.00 0.04 0 0.001 0.00 0. 0 0.001 0.00 0. 0 �O.Col 0.00 0.04 0 0.001 0.00 0.001 0 0.001 0.001 0. 0 0.001 0.001 0. 0 0.0010.001 G.00j 0 0.001 O.D01 0.001 0 0.001 O.D01 0. 0 ONO 0.001 0.04 0 0.001 0.001 0.04 0 0.001 0.001 0.001 0 ONO 0.00 0. 0 0.0cl 0.00 0. 0 0.001 O.D01 I I 1 0. Total Ponder Request Fringe Benefits $375. $28.6 3,0. $0-001 sO.Oq $0. $28.6 IN IL IN , INMIN 3-R� .� �� rt e SELvI � f a rr^rrr� ReIN �vx4? rfv N ROOD a34.t Sr1erJ0013', .# hu.�'- tfi,�y F, • _ f, r M,': Ti 'rq � �.' 3pr i y, } < ,.ter s Cultural Council of Indian River County After School Arts Program 2004 JIM' ! M Travel-Dolly 750.0 500.0 5.000. Bus Rental/Gas for Field Trips $150 per field Trip/5 . 27 trips = $750 Travel/Conferences/Tralnin 0.0 0.0 . . : _ . 3,500. 2 Office Supplies 160.0 _ .. 160.0 800. ..E 29 $20 per month for 8 months =$760 - Telephone r 2 280.0 1 .140-0 - 4,000.01 • $285 per month (one third cost for one rine) x 8 " months = $2280 per year. one fine of three used 30 for program Postage/Shipping 148.0 148.0 4,500. 31 400 pieces of mail Q .37 per piece Utilities : : - 32 Included in occupancy Occupancy (Building t Grounds) 2.221 .0 2.221 .0 9,575. Mortgage/Rent $833 per month ; Program uses one workstation of tree for 8 nanths $833 /3 = 33 277.66 per month x 8 month = $2221 per year 01 1 Printing II. Publications 150.0 150.0 10,000.00 500 copies per monthQ .03 = $15 per month x 8 months = 5120; 1 Box of copy paper = $30.00 34 Total = $143.00 - subscription/Dues/Memberships - 70.0 0.0 2,050.00 35 Dues for Arts for a Complete Education $70.00 Insurance 9.000.0 5.248.0 12,000. 0 ..u, .. .. _ - . . .- _. . . _ - . . . . . • Directors/Officers Ldab= $1150.00 • Wonnan s Comp = $2450.00 CommerclaUGeneral Insurance= $4950 Student 36 Accident $450 Total = $8987.83 E ui ment:Rental 3 Maintenance _ 0.0 0.0 4,000.00 Advertising 0.0 0.0 33.000.00 Equipment Purchases:Ca ital Expense 0.0 0.0 0. 3 Professional Fees (Legal, Consult 14 200.0 14 200.0 90,350. • $20 per hour for Art Instructors, $1.5 hours per week = $30 hours per week x 34 weeks = $1020 40 per instructor x 14 Instructors = $14,200.00 Books/Educational Materials - -_ 6467.3~ 1000.0 12,600.DC 41 $431 per instnrctor x 15 instructors = $6468.00 . r IN * Food 6 Nutrition - 0.0 0.0 0.001 42 Administrative Costs - 0.0 0.0 4 Audit Expense44 50 • Independent Audit Review ' -y- - - - 12 .0 1250.0 4,000.01- - - = - 45 Specific Assistance to Individuals 0.0 0.0 0. Other/Miscellaneous - 0.0 0.0 8.000. ' 46 Regrantng $8000 _. . - . . -. OtheNContraet __._ 4900.0 4900.0 7,726. Program Coordinator 300 hours Q $15 per hour $4500; Program Evaluator $20 per hour ; 20 hours -? 4 total = $400 = $4900 Total 48 TOTAL EXPENSES $42,D00.00 $34.320.6 5275,031 . - +yx�tt ' 4'•r' y rb s 3 »wF Y .a, ' b L 'y 7 xTi r till n 4r F , 4 .. 4 r..- l� F % kr .I !�i^3p�'$$$'��,}6h i;aFpy 'F k Y. ; 4 7�t�gy, d Nl� n ' •M �. ? u ; Al If If fei IfZ d at ' rs .kyr If F a ¢ , . z. r l " '$°i, •'3 'N ?�,,h'^Ir � C' ,`.x �w, � .+a r . , . x fr .`rae: _ ` . . i, �� Cultural Council of Indian Rim County Mer School Ms Program 2004 UNIFORM GRANT APPLICATION TOTAL AGENCY BUDGET Cultural Council of Indian River County FY 02/03 - FY 03/04 FY 04/05 % INCREASE FYE_09/30103 FYE 09/30/04 FYE 09/30105 CURRENT VS. NEXT FY BUDGET A B C D ACTUAL TOTAL PROPOSED (col. Csol. 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 Committee-Indian River 82 411 .00 88 000.00 88 000.00 0.00% 4 United Wa St Lucie County 0.00 #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 #DIVI01 e County Funds 111 719.00 133 400.00 133 400.00 0.00% 9 Contributions-Cash 3 672.00 5 700.00 5700=L==00 0.00% 10 Program Fees 485.00 0.00 #DIV/01 11 Fund Raising Events-Net 23 097.00 33 500.00 33 500.00 0.00% 12 Sales to Public-Net 0.00 #DIV/01 13 Membership Dues 10 360.00 10 000.00 10 000.00 0.00% 14 Investment Income 173.00 0.00 #DIV/01 15 Miscellaneous 1 ,639.0011 12100.001 11100.00 0.00% 16 Legacies & Bequests 0.00 #DIV/01 17 Funds from Other Sources 2110643.00 8 000.00 82000.00 0.00% 18 Reserve Funds Used for Operating 0.00 #DIVI01 19 In-Kind Donations (Noe Included In total) 28 500.00 0.00 #DIV/01 20 TOTAL 255 099.00 279 700.00 279 700.00 0.00% EXPENDITURES 21 Salaries 87 854.00 59 480.00 59 480.00 0.00% 22 FICA 71027.0011 47550.001 41550.00 0.00% 23 Retirement 0.00 #DIV/01 24 Life/Health 61700.001 0.00 #DIV/01 25 Workers Compensation 0.00 #DIV/01 26 Florida Unemployment 0.00 #DIV/01 27 Travel-Daily 175.00 51000.00 57000.00 0.00% 28 Travel/Conferences/Training 3 500.003 500.00 0.00°A 29 Office Supplies 11800.00 800.00 800.00 0.00°k 30 Telephone 3 400.00 4 000.00 4 000.00 0.00% 31 Postage/Shipping 41268.00 49500,00 41500.00 0.00% 32 Utilities 0.00 #DIV/Ol 33 Occupancy (Building & Grounds 11 160.00 91575.00 91575.00 0.00% 34 Printing & Publications 71463.00 10 000.00 10 000.00 0.000A 35 Subscrition/Dues/Membershf s 1 583.00 29050.00 21050.00 0.00% 36 Insurance 12 4•r 1.00 1200000 12 000.00 0.00% 37 E ui ment:Rental & Maintenance 4t284.00 49000.00 4 000.00 0.00% 38 Advertising 3t247,00 33 000.00 33 000.00 0.00% 39 Equipment Purchases:Ca ital Expense 438.00 0.00 i #DIV/01 40 Professional Fees (Legal, Consulting) 72 797.00 90 350.00 90t350.00 0.00% 41 Books/Educational Materials 51269.00 12 500.00 1250000 0.00% 42 Food & Nutrition 91387.001 0.00 #DIV/01 43 Administrative Costs 0.00 #DIV/01 44 Audit Expense 4,055.001 4 000.00 41000.00 0.00% 45 Specific Assistance to Individuals 0.00 #DIV/01 46 Other/Miscellaneous 413.00 81000.00 81000.00 0.00% 47 Other/Contract 15 726.00 71726,00 7,726.00 0.00% 48 TOTAL 259 463.00 275 031 .00 275 031 .00 0.00% 49 REVENUES OVER/ UNDER EXPENDITURES 4 364.00 4,669.00 4,669.00 0.00%° i I .P�,?""'. . . . . . ; . d ' . ,. �w.»�7L�'• .,. L • 'stp7*1r �f�;*-i'yl'�s .A GrYt � tit Cultural Council of Indian River County Mx SGwol Arts Program 2004 UNIFORM GRANT APPLICATION TOTAL PROGRAM BUDGET AGENCYIPROGRAM NAME: Cultural Council of Indian River County/ After School Arts Program FY 02/03 IFY 03104 FY 04/05 % INCREASE FYE 09130/0"• FYE 091=4 FYE 09130105 CURRENT VS. NEXT FY BUDGET A B C D ACTUAL TOTAL PROPOSED (col. C-col. 6ycol. e REVENUES BUDGETED BUDGETED 1 Children's Services Council-St. Lucie 0.00 #DIV/01 2 Children's Services Council-Martin 0.00 #DIV/Ol 3 Advisory Committee-Indian River 35 000.0035 000.00 35 000.00 0.00°/0 4 United Way-St Lucie County 0.00 #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 0.00 #DIV/0l 9 Contributions-Cash 51000.001 1 0.00 #DIV/01 10 Program Fees 0.00 #DIV/01 11 Fund Raising Events-Net 0.00 #DIV/0l 12 Sales to Public-Net 0.00 #DIV/01 13 Membership Dues 0.00 #DIV/01 14 Investment Income 0.00 #DIV/01 15 Miscellaneous 0.00 #DIV/OI 16 Legacies & Bequests 0.00 #DIV/Ol 17 Funds from Other Sources 29000.00 71000.00 700000 0.00% 1a Reserve Funds Used for Operating 0.00 #DIV/01 19 In-Kind Donations (Not Included In total) 10 576.00 10 576.00 #DIV/01 20 TOTAL 42 000.00 4200000 42 000.00 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/0l 24 Life/Health 0.00 #DIV/01 25 Workers Compensation 0.00 #DIV/01 26 Florida Unemployment 0.00 #DIV/01 27 Travel-Daily 750.00 750.00 750.00 0.00% 2a Travel/Conferences/rrainin 0.00 #DIV/01 29 Office Supplies 160.00 160.00 160.00 0.00% 3o Telephone 1 140.00 11140.001 29280,00 100.00% 31 Postage/Shipping 143.00 148.00 148.00 0.00% 32 Utilities 0.00 #DIV/01 33 .Occu anc (Building & Grounds 31046,00 31333.00 2#221 .00 -33.36% 34 Printin & Publications 170.00 150.00 150.00 0.00% 35 Subscri tion/Dues/Membershi s 70.00 70.00 70.00 0.00% 36 Insurance 81653,00 9 000.00 9 000♦00 0.00% 37 E ui ment:Renfal & Maintenance + 0.00 #DIV/O! 38 Advertising 0.00 #DIV/01 39 Equipment Purchases:Ca ital Expense 0.00 #DIV/01 40 Professional Fees (Legal, Consulting) 1664000 1420000 14220 0.00% 41 BookslEducational Materials 49330.62 69495.31 69467.31 -0.43% 42 Food & Nutrition 0.00 #DIV/0l 43 Administrative Costs 0.00 0.00 #DIV/01 44 Audit Expense 19650.00 11250.00 11250,00 0.00% 45 Specific Assistance to Individuals 0.00 #DIV/01 46 Other/Miscellaneous 0.00 #DIV/0l 47 Other/Contract 4t843.69 41900.00 41900.00 0.00% 48 TOTAL 42 000.004200 0.000.00 4;t 000.00 0.00% 49 REVENUES OVER/ UNDER EXPENDITURES 0.00 0.001 #DIV/01 r 1. Ie [ S a � { gays� .f , ` " t,p / It . 1 S� n F,, $ s To Cultural Council of Indian River County After School Arts Program 2004 UNIFORM GRANT APPLICATION FUNDER SPECIFIC BUDGET PROGRAM EXPENSES AGENCY/PROGRAM NAME : Cultural Council or Indian River Cty/After School Arts Program 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. B/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/O ! 26 Florida Unemployment 0.00 0 .00 #DIV/O ! 27 TravelmDally 750.00 500 .00 66 .67% 28 Travel/Conferences/Training 0 .00 0 .00 # DIV/01 29 Office Supplies 160 .00 160 .00 100 .00% Bo Telephone 21280 .00 19140 .00 50 .00% 31 Postage/Shipping 148 .00 148 .00 100 .00% 32 Utilities 0 .00 0 .00 #DIV/0 ! 33 Occupancy (Building & Grounds 21221 .00 21221 .00 100.00% 34 Printing & Publications 150.00 150 . 00 100.00% 35 Subscri tion/Dues/Membershi s 70 .00 0 . 00 0.00% 36lnsurance 91000 .00 59248 .00 58 .31 % 37 Equipment: Rental & Maintenance 0. 00 0 .00 #DIV/01 38 Advertising 0.00 0 .00 #DIV/01 39 Equipment Purchases : Capital Expense 0.00 0 .00 � #DIV/01 40 Professional Fees ( Legal , Consulting) 149200 .00 149200 .00 100 .00% 41 Books/Educational Materials 61467. 31 4 , 000 .00 61 .85% 42 Food & Nutrition 0 .00 0 .00 #DIV/01 43 Administrative Costs 0 .00 0 .00 #DIV/01 44 Audit Expense 19250 .00 1 ,250 .00 100.00% 45 Specific Assistance to Individuals 0 .00 0 .00 #DIV/01 46 Other/Miscellaneous 0 .00 0 .00 #DIV/0 ! 47 Other/Contract 4,900 .00 4,900 .00 100 .00% ` ` $42000 .00 $3432069 $ 1 .72 /o 48 TOTAL' : ,� -� �.: . ; . , , . o All ellrj 04 ill C < iW4 YET i r?4���` .�+ .r1Fiv r4�AS; =h + , j , •�} . " r x.R'F�"T1i ` .. , " .i . , t . 'e: • Typ*ft 0rpentzw%n w4 PrOWM Ns UNIFORM GRANT APPLICATION EXPLANATION FOR VARIANCES OF 16% OR MORE TOTAL PROGRAM BUDGET AGENCYIPROGRAM NAME: Cultural Council of Indian River County/After School Arts Program FUNDER:Children's Services Advisory Committee -Indian River County N IIR N,A�FAOA�' ' 1i41tC ... #DIVIOI No exptanations necessary #DIVl01 #DIVIOI #DIVI01 #DN/0l #DN/01 #DIV/01 #DIV/01 #DN/01 #DIVI01 #DNI I #DNI01 #DIVIOI #DIV/01 #DNI01 #DIVIOI #DIVIOI #DN/01 #DIV101 #DIVI01 #DIVI01 f #DIVI01 Telephone #DNI01 #DIVIOI #DIVI01 #DIVIOI #DIVIOI <' #DIVIOI #DIV/0l #DIVI01 11 '1,.A. si b :� n � . . . i t,B 01 *TFC 'y.� { . . r At .t +gyp. 4 p M < y� + At P araxF i f 1At 4Fv° "-III , I ° ' > PayMi c e I ' F _ ..a �! 5 l +1>n 'Y �. �tRT w 'PI^ t y tsa r"V, :F 3 "L *t}j > :r In �yA ^' n t rf,(ry, x� C J,�" t 9� _ X . i f �, . ."`s ,nG. '" di; ..•i' . TM tln OrgwAmlbn and Pmgre Nam UNIFORM GRANT APPLICATION EXPLANATION FOR VARIANCES OF 15% OR MORE FUNDER SPECIFIC BUDGET AGENCYIPROGRAM NAME: Cultural Council of Indian River County/After School Arts Program FUNDER:Children's Services Advisory Committee -Indian River County Salaries Asking for 3% of bookeeeping Salary & Fringe; Processing Reimbursements FICA #DNlOI #DNI01 #DN/01 #DNI01 Travel-Dai $500 of $750 = Bus Rental/Gas for field trips, 5 field trips, $ 150 each, to encourage offsite cultural experiences, ie: Museum/Theatre #DNI01 Office Supplies $ 160 = needed for minmal office supplies; $20 per month for envelopes, paper, printer cartridges, dips, binders, markers, pens Telephone $ 1140 of $2280= $285 per month x 8 months asking for one halt the cost of dedicating one fine for program use Postage/Shipping $148 = 400 pieces of mail at .37 each #DN/01 Occupancy (Building & Grounds Mortgage/Rent $833 per month ; Program uses one workstation of three for 8 months $833 /3 = 277.66 per month x 8 months = $2221 per year Printing & Publications 500 copies per month@ .03 = $15 per month x 8 months = $120; 1 Box of copy paper = $30.00 Total = $143.00 $5248 of $9000 = Liability Insurance = $4950; Workman's Comp = $2450; Student Accident = $450 asking for assistnace with this Insurance rising cost #DIV/01 #DIVI01 #DN/01 Professional Fees (Legal, Consulting) $20 per hour for Art Instructors, $1 .5 hours per week = $30 hours per week x 34 weeks = $1020 per instructor x 14 instructors = $14,200.00 Books/Educational Materials $431 per instructor x 15 instructors = $6468.00; asking for a portion of this cost #DNlOI #DIV101 Audit Expense $ 1250, asking for one third share of audit review #DN/01 #DIV/01 Other/Contract Program Coordinator 300 hours @ $15 per hour = $4500; Program Evaluator $20 per hour ; 20 hours total = $400 = $4900 Total (- 'a�}yt .fir` r• l' '+ t-. � i ry a fl ' sr t }'�, t s > _ Si +�{ d t r^ i •/- + iA. l g1 .yn. ri • ; t � r y T �. . *' 3� _. i� I I Hr ... ' ^ r n?�, t• Ft w" ,. `' Pkv ,+'. .t� a sv yr , = R t s • '+ G,yri $ . a '.Sv .y S 'tY kieM'1 . `yt„t 4t�F' iY l rw# 5 i fY �Ypj 4Y5•F1�L ' .? 7.: Cultural Council of Indian River County; After School Arts Program Children' s Services Advisory Committee 2004 Not for Profit Agency Certification The County of Indian River requires , as a matter of policy, that any Consultant or firm receiving a contract or award resulting from the Request for Qualifications issued by the County of Indian River, Florida , shall make certification as below. Receipt of such certification , under oath , shall be a prerequisite to the award of contract and payment thereof. (we ) hereby certify that if the contract is awarded to me , our firm , partnership , or corporation , that no members of the elected governing body of Indian River County, nor any professional management, administrative official or employee of the County, nor members of his or her immediate family, including spouse , parents , or children , nor any person representing or purporting to represent any member or members of the elected governing body or other official , has solicited , has received or has been promised , directly or indirectly, any financial benefit, including but not limited to a fee , commission , finder' s fee , political contribution , goods or ser%✓ices in return for favorable review of any Proposal submitted in response to the Request for Qualifications or in return for execution of a contract for performance or provision of services for which Proposals are herein sought. The undersigned certifies that he/she is a principal or officer of the firm applying for consideration and is authorized to make the above acknowledgments and certifications for and on behalf of the applicant. The undersigned certifies that the Applicant has not been convicted of a public entity crime within the past 36 months , as set forth in Section 287 . 133 , Florida Statutes . Failure to sicjn this form will result in disqualification., Handwritten Signature of Authorized Principal 's) : DATE: NAME : Sheila Tucker E n OIL ko�4 TITLE: Chairman of the Board of Directors NAME OF FOR AND ON BEHALF OF THE APPLICANT: FIRM/PARTNERSHIP/CORP ORATION : , Cultural Council of Indian River County Sworn to and subscribed to me , a Notary Public, this i / day of , 2004 . Y: q�zj a r% a e0oe. tod .Z ( fes. p � (,d6►onDO�y � (TYPE NAOE & TITLE) 20pj 5144 �. 1. tc < 1 Y Lam , r, ss 6.4,i,'vNS 1 m : 14 s�, It 7L It iL r Cultural Council of Indian River County; After School Arts Program Children' s Services Advisory Committee 2004 Indian River Board of County Commissioners 1840 25th Street Vero Beach , FL 32960 AUTHORIZATION FOR RELEASE OF INFORMATION Indian River County and Cultural Council of Indian River County are in the process of negotiation of a contract for After School Arts Program . Indian River County is authorized to make an investigation of the Agency/Individual regarding its experience and qualifications . The Agency/ Individual authorized the release of all relevant information concerning prior services furnished , contracts and background information of the Agency/Individual . The Agency/Individual authorizes any individual or organization that is in possession of relevant factual contract and background information , to release such data to Indian River County in response of the County' s request. When an individual employee of the Agency signs Authorization for Release of Information , such individual authorizes the County to obtain relevant background information concerning such employee' s criminal record , if any, and such other information that may be relevant to employee' s good character and work experience . Authorization is given here by the Agency/ Individual and such employees who execute this authorization with the understanding and limitation that Indian River County will utilize the information obtained for the purposes set forth herein and that such information shall not be disclosed to third parties except as provided by law. Name Agency/Individual Cultural Council of Indian River County Name Employee Providing authorization Mary Jayne Kelly Signature ( in blue ink) W41 ' Date : May 19 , 2004 t y A r K7 1 � %' ] aF `=t4a I ?.4£� �. t �* -s4.•" . . . , s ' ?-; . � rr .f n;�` ��' 4.*4-'.'•2#,� i , ii ( .''-''= Cultural Council of Indian River County; After Schcol Arts Program Children' s Services Advisory Committee 2004 SWORN STATEMENT UNDER SECTION 105 . 08, INDIAN RIVER COUNTY CODE, ON DISCLOSURE OF RELATIONSHIPS THIS FORM MUST BE SIGNED IN THE PRESENCE OF A NOTARY PUBLIC OR OTHER OFFICER AUTHORIZED TO ADMINISTER OATHS . 1 . This sworn statement is submitted with RFP No . 6067 for After School Arts Program 2 . This sworn statement is submitted by : Cultural Council of Indian River Courrtiy Whose business address is : 214514 th Ave . , Suite 11 , Vero Beach , Florida 32960 and its Federal Employer Identification Number ( FEIN ) is 59 -3299133 3 . My name is Mary Jayne Kelly and my relationship to the entity named above is Executive Director , 4 . 1 understand that an " affiliate" as defined in Section 105 . 08 , Indian River County Code , means : The term " affiliate" includes those officers , directors , executives , partners , shareholders , employees , members , and agents who are active in the management of the entity. 5 . 1 understand that the relationship with a County Commissioner or County employee that must be disclosed as follows : Father, mother, son , daughter, brother, sister, uncle , aunt, first cousin , nephew, niece , husband , wife , father-in-law, mother-in-law, daughter- in4aw, son-in-law, brother-in-law, sister-in-law, stepfather, stepmother, stepson, stepdaughter, stepbrother, , stepsister, half brother, ., half sister, grandparent ,, or . grandchild. 41 a .r t i iv rz Y , wkr»f', F" 4 s 4+vtn n Q ,1 4 . L 111 ♦ £ If If, If- 1 11 If If X '.... C If IfI If? r, °,i'', ,^. Cultural Council of Indian River County; After School Arts Program Children' s Services Advisory Committee 2004 6. Based on information and belief, the statement, which I have marked below is true in relation to the entity submitting this sworn statement. [ Please indicate which statement applies . ] Neither the entity submitting this sworn statement , nor any officers , directors , executives , partners , shareholders , employees , members , or agents who are active in management of the entity, have any relationships as defined in section 105 . 08 , Indian River County Code , with any County Commissioner or County employee . X The entity submitting this sworn statement, or one or more of the officers , directors , executives , partners , shareholders , employees , members , or agents , who are active in management of the entity have the following relationships with a County Commissioner or County employee : Name of Affiliate Name of County Commissioner Relationship or entity or employee Cultural Council of Mr. Kenneth Macht Board Member Indian River County � N N +axile s M,. 4, tilt { ddddd � �� , •�5 � .n , 1&.5 ' i Y . '•5 eta 'b x Cultural Council of Indian River County; After School Arts Program Children' s Services Advisory Committee 2004 ( signat e ) ( date) STATE OF COUNTY OF ,0 (!- K The foregoing instrument was gcknowled d before me this day of M , 2004 , by , who is personally known to me or who has produced �FL> L1=4 as identification . N TARY UBL C SIGN : P b t of Florida at Large My Commission Expires : ( Seal ) Jw"e mod*" a 00m April 1 2W FF T OW ' * Y 3 F3 fiYi it � Ml �.(4 :. fir « t Ku r < _ ✓. t . ..i.,.�l�.�`c' ..+k : . . :. : . , ' a «',ag ,; :. , , •i- +ems`. r t , . . " , '";L'�4 . e .& f , ., f ;` , ,, :. s?. , . , 5�ne; Board of Directors Cultural Council 2004 First Last Address City State Zi Position Officers: Sheila B. Tucker 127 Prestwick Circle Vero Beach FL 32967 Chairman Richard Stark 340 Palmetto Point Vero Beach FL 32963 Vice Chairman Ellen Fischer 1580 5th Court Vero Beach R. 32963 Secretary Janice Broda 12396 North AIA Vero Beach FL 32963 Treasurer Susan Smith 1342 Riverside Lane Vero Beach FL 32963 Cultural�Advisory Chairman Board Members: Ray Adams 3065 Buckie hammock Trail Vero Beach FL 32960 Nancy Bryant 1550 Old Dbde Hwy. Vero Beach FL 32960 Jafar Falasid 2370 North US 1 Vero Beach FL 32960 Barbara Ferrell 875 Crescent Beach Rd, Vero Beach FL 32963 Peter Ford 1789 Coral Way Vero Beach FL 32963 Dorothy Hudson 603 17th St. Suite 101 Vero Beach FL 32960 Ma Knapp 4831 S Newport Island Dr. Vero Beach FL 32967 Marcia Loewinger 49 Royal Palm Pointe Vero Beach FL 32960 Comm. Ken Macht 1840 25th St, Vero Beach FL 32960 Barbara K. Miller 131 Twin Island Reach Vero Beach FL 32963 Robert L Richardson 966 34th Ave. Vero Beach FL 32960 Margie Segal 1409 W Island Club Sq Vero Beach FL 1329631 Robert L Temple P.O. Box 5064 Vero Beach FL 32961 Mark Wygonik 542 9th PI. Vero Beach FL 32960 F J L VA r ( 5/18/2004 .: $C,_ NOV - 11 - 2004 10 : 33 AM CULrURAL . COUNCIL . IRC 77277e34e3 P003 WORMS COMPENSATION AND 3MPL(',--YERS _ TABILITY INSURANCE POLICY WC 99 06 01 A REISSUE INFORMATION PAGE RENEWAL AGREEMENT Insurer ; Produce : : Agent # 722 Harbor Specia _ ty Insurance Company Sid Banack Insurance C / C Unisource Administrators , I . b , 0 . Box 130 5951 Cattieridge Blvd . , Suite 2CO Vero Beach , FL 32961 Sarasota , FL 34232 ( Carrier Code. : 35270 ) 024 Car _• '_ et• Policy 7 : 0 ) 9000004981203 Carrier Pr _ or Poliny # : 09900000498 .1, 202 '. . The Insured : Cultural of Tn. dian Rive .r County , Type of Business : Cc .rporation Mailing Address : 2145 '_ 4 Ave 811 Vero Beac .7 , 1710 32960 Other ts, rkplaces not shown abovs , Fein : 593299133 NO OTHER WORK ?LACES FOR ^. HIS POLICY Risk ID : 2 . The. IV olicy period is from 12 : 01 f . m , on L / 20 / 2003 to 12 : 01 a . m . on 17 / 20 ' 2004 s - the in sured ' s mailing acdress . A . Workers Compensatton. Insurance Part One of the pelicy applies - o the Workers Compensation L. aw of : he states listed here : FL 1' . Cmployers Liability Incurs: nce : Pa .� t Two of _ he policy app _ ies to work. in each state listed in Item 3 . A . The lir: ' . ., of a : r li, abi, l, ity under Part Two are : Bndi ? y Injury by Accident $ 1 ; 01000 each accident Bodily Injury by Disease $ 500 , 000 policy lima = Bodily Injury by Disease $_ _ 100 . 000 each emiloyr;: e% C . Other States Insurance : D . This poli , y .in.r? ude. s these endorsen; ert .1 al", d s � hecules : WC000000A ( 04 / 92 ) WC000414 ( 07 / 90 ) WCOOU420 , '12002 ) WC090606 ( 10 / 98 ) 4 . ?. he premium for this policy will b+ determined i; i our Manuals of RuIeS , Classifications , Rates and Rating Flans , Al .. i211Crmat. ' on .r. equi = ed below is subject to verification and change by auall, . CIass1ficet '_ ans Code Premium Iasis Rate ? er Estimated No . 'ctal Estimated $ 10i, of Annual Innual. Remuneration Remuneration Premium SEE SCF: EDULE OF 07ERATTONS Lota : 7stimated Annual Prem "_ um Minimum Premum S 50 , 00rrpensr. " oP.. :; tar, 3 240 . 00 WC 99 'i f; 01 A Ccu : : t . d by ✓,!JAI:Rt OCT - 29 - 2004 08 : 54 AM CULTURAL . COUNCIL . IRC 77277234013 Pool Internal Revenue Service Department of the Treasury P . O. 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 . Toll Free Telephone Number : 214514 M Ave . Ste , 11 877-829-5500 Vero Beach , FL. 32960-4413 Fax Number : 513-263 -3756 Federal identification Number: 59-3299133 Dear Sir or Madam : This letter is in response to cur receiving your correspondence concerning your Advanced Ruling 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(a)(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 filed by the 15th day of the fifth month after the end of the organization's annual .accounting , pedod . 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 Federal 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 . Dono7s 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 2522 of the Code . OCT - 29 - 2004 08 : 55 AM CULTURAL . COUNCIL . IRC 7727703403 Pa02 i Cultural Council of . Indian 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 determining 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 "ate of the return : You are also required to make available for public inspection a copy of your organization's exemption application , any supporting document's 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 public 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 and foundation status, you should keep it with the organization's permanent records . . If you have any questions , please call us at the telephone number shown in the heading of this letter. This letter affirms your organization's exempt status . Sincerely, ioirr � Robert C . Padilla Manager, Customer Service , 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 1s' may be reimbursed with funds from the following year. Additionally, if any funds are unexpended at the end of a fiscal year, these funds are not carried over to the next year unless expressly authorized by the Board of Commissioners . All requests for reimbursement at fiscal year end (September 30th) must be submitted on a timely basis . Each year, the Office of Management & Budget will send a letter to all nonprofit agencies advising of the deadline for reimbursement requests for the fiscal year. This deadline is typically early to mid October, since the Finance Department does not process checks for the prior fiscal year beyond that point . Each reimbursement request must include a summary of expenses by type . These summaries should be broken down into salaries , benefits , supplies , contractual services , etc . If Indian River County is reimbursing an agency for only a portion of an expense (e . g . salary of an employee) , then the method for this portion should be disclosed on the summary. The Office of Management & Budget has summary forms available . Indian River County will not reimburse certain types of expenditures . These expenditure types are listed below. a . Travel expenses for travel outside the County including but not limited to ; mileage reimbursement , hotel rooms , meals , meal allowances , per Diem , and tolls . Mileage reimbursement for local travel (within Indian River County) is allowable . b . Sick or Vacation payments for employees . Since agencies may have various sick and vacation pay policies , these must be provided from other sources . c. Any expenses not associated with the provision of the program for which the County has awarded funding . d . Any expense not outlined in the agency's funding application . The County reserves the right to decline reimbursement for any expense as deemed necessary." - 1 - EXHIBIT C STANDARD TERMS FOR GRANT CONTRACT 1 . Notices : Any notice , request, demand , consent, approval or other communication required or permitted by this Contract shall be given or made in writing , by any of the following methods : facsimile transmission ; hand delivery to the other party; delivery by commercial overnight courier service; or mailed by registered or certified mail (postage prepaid ) , return receipt requested at the addresses of the parties shown below: County: Joyce Johnston-Carlson , Director Indian River County Human Services 184025 th Street Vero Beach , Florida 32960-3365 Recipient : : Cultural Council of Indian River 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 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 - Cultural Council of Indian River J9000 ow County Web site : www_cultural-council_org 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 25th Street Vero Beach, Florida 32960 -3365 Board Ray Adams Dear Ms . Jordan, Nancy Bryant Jafar Falasiri Please be advised that the Cultural Council of Indian River County does not own , Barbara Ferrell 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 Macht Mark 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, FL 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 1111 " R2004 18 : 52 FAX 772 562 3 .166 SID BANACK INS . 0001 / 001 RACRDCERTIFICATE OF LIABILITY INSURANCE DATE (MMlDDlYYYY} TM SNOV 17 04 * PROCUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION SID 19ANACK INS .IA HILB ROGAL S HOBS 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 SY THE POLICIES ® ELOW. VERO BENCH FL 32961 1 INSURERS AFFORDING COVERAGE NAIC # INSURED II NSUR£R A, ESSEX INSURANCE COMPANY CULTURAL COUNCIL OF INDIAN RIVER COUNTY, INC . INSURER 9, HARBOR SPECIALTY INSURANCE CO 2145 14TH AV #11 _ ,.. _- - _ VERO BEACH FL 32960 INSURER C' _ _ - INSURER D, - I ! INSURER EI I COVERAGE$ THE FOLICIES OF INSURANCE LISYED BELOW HAVE SEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDIN3 ANY REOUIREMENT, TERM OR CONDITION OF ANY CONYRACT OR OTHER DOCUMENT WITH RESFECT TO WHICH THIS CERT{FICATE MAY BE iSSUED OR MAY PERTAIN, THE INSURANCE AFFORDEO BY TME POLICES DESCRI©ED HEREIN IS SJBJECT TO ALL THE TeRMS, CXCW$ IONS AND CONDITIONS OF SOCy FOLI ! ES. AGGREGATE LIMITS SHOWN MAY HAVE SEEN REDUCED BY PAID CLAIMS. IrSR ADO'L TYPE OF INSUA.4NCE POLL' NUMBER POUO>/ EF6ECT1Yp—POLICY EXPIRATION ! L1k , 'NBRO DATE MM/D0 DATE FAKOD LINSTS GENERAL LIABILITY 3CM8192 MAR 10 04MAR 10 05 EACH occuRRENCE 1 ,000,000 )( COMMERCIAL GENERAL LIAE0. DAMAGE TD REWTED 1TY1 50,000 I I CLAIMS MApEI X OCCUR I, I I MED. EXP (Any ore person! i x 1 ,000 A —_ I _ PERSONAL A ADV INJURY 1 P000P000 GENERAL AGGREGATE S 2P000,O00 'CEIYL AGGREGATE LIMIT APPLIES PER: PRODVCT$,COMPIOP AGG S 100000000 POLICY r . FRO.SaT 77 LOC : AUTOMOBILE LIAIP LITY COMBINED SINGLE LIMIT — 11 AN! AUTO (Ea 80c)( m) I @ I ALL OLIINED ALTOS BODILY INJURY----� — ', SCMEDULEC AUTOS : For PirrSon) g i HIRED AUTOS 80DILv INJURY j 3 NON•OWNEDAUT09 ! I ,Pseccl0eni, - --. . PROPERTY DAIMGE s accloenl� GARAGE UASIL ITY � AU7 0 ONLY - EA ACCIDENT � ANY AUTO 07MER IT AN EA_ ACC $ IAVT 00NLY- : S EXCESS I UMBRELLA LIASILII*yEACH OCCURRENCE.. _ , OC ! I OCCUR U C1dMS MApE ' AGGREGATE S 1 CEOVCTtBtF � � ' ---I RcrENYION 8 5 WOPJSERS COMPENSATION AND 099000004981203 DEC 20 03 DEC 2O 04 — "4 T omen EMPLOYER5' LMMLITPY — AfayPROPRIETOIUPARTNER/E]fECUTNE IE. L EACH ACCIDENT ' s 1_00 , 0_0013 OFFl6EFLMEMBER EXCOMED7 ' EL DISEA.SE.EA EMPLOYEE Is — 100 , 000 IIryes, Oescrlbe LrOtr I ....." ' ; BPFCIALPROV010WObolow - � CJ. L. DISEA$E•POLIC'rLIuIIT I $ $001000 OTHER. I i i I i I I DESCRIPTION OF OPERATIONSILOCATIONSIVEHICLESIEXCLUSIONS ADDED BY ENDORSEMENT! SPECIAL PROVISIONS CERTIFICATE HOLDER IS NAMED AS AN ADDITIONAL INSURED WITH RESPECT TO GENERAL LIABILITY, CERTIFICAT& HOLRER W — CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF. THE ISSUING COMPANY WILL ENDEAVOR TO MAIL PC CA,YS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, OUT FA'LURE TO DO SO SMALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INDIAN RIVER COUNTY INSURER, ITS AGENTS OR REPRESENTATIVES 1840 26TH STREET AUTHORIZED REPRESENTATIVE VERO BEACH, FL 32960 Attpnticiv HUMAN SERVICES-FAX: 971 1795 gB +Thi ' ACORID 25 (20011081 Certificate 9 82240 U ACORD CORPORATION 1088