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HomeMy WebLinkAbout2005-328j Novo 0 -00 INDIAN RIVER COUNTY .7 GRANT CONTRACT ' This Grant Contract ("Contract") entered into effective this day of October 2005 , by and between Indian River County, a political subdivision of the S t of Florida ; 1840 25th Street , Vero Beach , Florida , 32960- 3365 ; and Boys & Girls Clubs of Indian River County, Inc . , ( Recipient) , of: Boys & Girls Clubs of Indian River County, Inc. P . O . Box 643068 Vero Beach , Florida 32964 Sebastian Branch Background Recitals A. The County has determined that is in the public interest to promote healthy children in a healthy community. B . The County adopted Ordinance 99- 1 on January 19 , 1999 ("Ordinance") , and established the Children 's Services Advisory Committee to promote healthy children in a healthy community, and to provide a unified system of planning and delivery within which children 's needs can be identified , targeted , evaluated and addressed . C . The Children 's Services Advisory Committee has issued a request for proposals from individuals and entities that will assist the Children 's Services Advisory Committee in fulfilling its purpose . D . The proposal submitted to the Children 's Services Advisory Committee and the recommendation of the Children 's Services Advisory Committee have been reviewed by the County. E . The Recipient, by submitting a proposal to the Children 's Services Advisory Committee , has applied for a grant of money ("Grant") for the Grant Period (as such term is hereinafter defined ) on the terms and conditions set forth herein . F . The County has agreed to provide such Grant funds to the Recipient for the Grant Period (such term is hereinafter defined ) on the terms and conditions set forth herein . NOW THEREFORE , in consideration of the mutual covenants and promises herein contained , and other good and valuable consideration , the receipt and .adequacy of which are hereby acknowledged , the parties agree as follows : 1 . Background Recitals . The background recitals are true and correct and form a material part of this contract. 2 . Purpose of the Grant . The Grant shall be used only for the purposes set forth in the complete proposal submitted by the Recipient , attached hereto as Exhibit "A" and incorporated herein by this reference (such purposes hereinafter referenced as "Grant Purposes") . 3 . Term . The Recipient acknowledges and agrees that the Grant is limited to the fiscal year 2005/2006 ("Grant Period") . The Grant Period commences on October 1 , 2005 and ends on September 30 , 2006 . - 1 - Novo 0 -00 INDIAN RIVER COUNTY .7 GRANT CONTRACT ' This Grant Contract ("Contract") entered into effective this day of October 2005 , by and between Indian River County, a political subdivision of the S t of Florida ; 1840 25th Street , Vero Beach , Florida , 32960- 3365 ; and Boys & Girls Clubs of Indian River County, Inc . , ( Recipient) , of: Boys & Girls Clubs of Indian River County, Inc. P . O . Box 643068 Vero Beach , Florida 32964 Sebastian Branch Background Recitals A. The County has determined that is in the public interest to promote healthy children in a healthy community. B . The County adopted Ordinance 99- 1 on January 19 , 1999 ("Ordinance") , and established the Children 's Services Advisory Committee to promote healthy children in a healthy community, and to provide a unified system of planning and delivery within which children 's needs can be identified , targeted , evaluated and addressed . C . The Children 's Services Advisory Committee has issued a request for proposals from individuals and entities that will assist the Children 's Services Advisory Committee in fulfilling its purpose . D . The proposal submitted to the Children 's Services Advisory Committee and the recommendation of the Children 's Services Advisory Committee have been reviewed by the County. E . The Recipient, by submitting a proposal to the Children 's Services Advisory Committee , has applied for a grant of money ("Grant") for the Grant Period (as such term is hereinafter defined ) on the terms and conditions set forth herein . F . The County has agreed to provide such Grant funds to the Recipient for the Grant Period (such term is hereinafter defined ) on the terms and conditions set forth herein . NOW THEREFORE , in consideration of the mutual covenants and promises herein contained , and other good and valuable consideration , the receipt and .adequacy of which are hereby acknowledged , the parties agree as follows : 1 . Background Recitals . The background recitals are true and correct and form a material part of this contract. 2 . Purpose of the Grant . The Grant shall be used only for the purposes set forth in the complete proposal submitted by the Recipient , attached hereto as Exhibit "A" and incorporated herein by this reference (such purposes hereinafter referenced as "Grant Purposes") . 3 . Term . The Recipient acknowledges and agrees that the Grant is limited to the fiscal year 2005/2006 ("Grant Period") . The Grant Period commences on October 1 , 2005 and ends on September 30 , 2006 . - 1 - 4 . Grant Funds and Payment . The approved Grant for the Grant Period is : THIRTY ONE THOUSAND , FIVE HUNDRED NINETY THREE DOLLARS ($31 , 593 . 00 ) . The County agrees to reimburse the Recipient from such Grant funds for actual documented costs incurred for the Grant Purposes provided in accordance with this Contract . Reimbursement requests may be made no more frequently than monthly. Each reimbursement request shall contain the information , at a minimum , that is set forth in Exhibit "B" , attached hereto and incorporated herein by this reference . All reimbursement requests are subject to audit by the County. In addition , the County may require additional documentation of expenditures , as it deems appropriate . 5 . Additional Obligation of Recipient 5 . 1 , Records , The Recipient shall maintain adequate internal controls in order to safeguard the Grant . In addition , the Recipient shall maintain adequate records fully to document the use of the Grant funds for at least three (3 ) years after the expiration of the Grant Period . The County shall have access to all books , records , and documents as required in this Section for the purpose of inspection or audit during normal business hours at the County's expense , upon five (5 ) days prior to written notice . 5 . 2 . Compliance with Laws . The Recipient shall comply at all times with all applicable federal , state , and local laws and regulations . 5 . 3 . Quarterly Performance Reports The Recipient shall submit quarterly, cumulative , Performance Reports to the Human Services Department of the County, within fifteen ( 15) business days following : December 31 , March 31 , June 30 and September 30 . 5 .4 . Audit Requirements . If Recipient receives $25 , 000 , or more in aggregate, from all Indian River County government funding sources , the Recipient is required to have an audit completed by an independent certified public accountant at the end of the Recipient's fiscal year. Within 120 days of the end of the Recipient's fiscal year, the Recipient shall submit the audit to the Indian River County Office of Management and Budget. The fiscal year will be as reported on the application for funding , and the Recipient agrees to notify the County prior to any change in the fiscal period of Recipient . The Recipient acknowledges that the County may deny funding to any Recipient if an audit required by this Contract for the prior fiscal year is past due and has not been submitted by May 1 . 5 .4 . 1 . The Recipient further acknowledges that, promptly upon receipt of a qualified opinion from its independent auditor, such qualified opinion shall immediately be provided to the Indian River County Office of Management and Budget . The qualified opinion shall thereupon be reported to the Board of Commissioners and funding under this Contract will cease immediately. The foregoing termination right is in addition to any other right of the County to terminate the Contract . 5 .4 .2 . The Indian River County Office of Management and Budget reserves the right at any time to send a letter to the Recipient requesting clarification if there are any questions regarding a part of the financial statements , audit comments , or notes . 5 . 5 . Insurance Requirements . Recipient shall , no later than September 21 , 2005 provide to Indian River County Risk Management Division a certificate, or certificates , issued by an insurer, or insurers , authorized to conduct business in Florida that is rated not-less-than Category A- :VII by A . M . Best , subject to approval by Indian River County's Risk Manager, of the following types and amounts of insurance : - 2 - 4 . Grant Funds and Payment . The approved Grant for the Grant Period is : THIRTY ONE THOUSAND , FIVE HUNDRED NINETY THREE DOLLARS ($31 , 593 . 00 ) . The County agrees to reimburse the Recipient from such Grant funds for actual documented costs incurred for the Grant Purposes provided in accordance with this Contract . Reimbursement requests may be made no more frequently than monthly. Each reimbursement request shall contain the information , at a minimum , that is set forth in Exhibit "B" , attached hereto and incorporated herein by this reference . All reimbursement requests are subject to audit by the County. In addition , the County may require additional documentation of expenditures , as it deems appropriate . 5 . Additional Obligation of Recipient 5 . 1 , Records , The Recipient shall maintain adequate internal controls in order to safeguard the Grant . In addition , the Recipient shall maintain adequate records fully to document the use of the Grant funds for at least three (3 ) years after the expiration of the Grant Period . The County shall have access to all books , records , and documents as required in this Section for the purpose of inspection or audit during normal business hours at the County's expense , upon five (5 ) days prior to written notice . 5 . 2 . Compliance with Laws . The Recipient shall comply at all times with all applicable federal , state , and local laws and regulations . 5 . 3 . Quarterly Performance Reports The Recipient shall submit quarterly, cumulative , Performance Reports to the Human Services Department of the County, within fifteen ( 15) business days following : December 31 , March 31 , June 30 and September 30 . 5 .4 . Audit Requirements . If Recipient receives $25 , 000 , or more in aggregate, from all Indian River County government funding sources , the Recipient is required to have an audit completed by an independent certified public accountant at the end of the Recipient's fiscal year. Within 120 days of the end of the Recipient's fiscal year, the Recipient shall submit the audit to the Indian River County Office of Management and Budget. The fiscal year will be as reported on the application for funding , and the Recipient agrees to notify the County prior to any change in the fiscal period of Recipient . The Recipient acknowledges that the County may deny funding to any Recipient if an audit required by this Contract for the prior fiscal year is past due and has not been submitted by May 1 . 5 .4 . 1 . The Recipient further acknowledges that, promptly upon receipt of a qualified opinion from its independent auditor, such qualified opinion shall immediately be provided to the Indian River County Office of Management and Budget . The qualified opinion shall thereupon be reported to the Board of Commissioners and funding under this Contract will cease immediately. The foregoing termination right is in addition to any other right of the County to terminate the Contract . 5 .4 .2 . The Indian River County Office of Management and Budget reserves the right at any time to send a letter to the Recipient requesting clarification if there are any questions regarding a part of the financial statements , audit comments , or notes . 5 . 5 . Insurance Requirements . Recipient shall , no later than September 21 , 2005 provide to Indian River County Risk Management Division a certificate, or certificates , issued by an insurer, or insurers , authorized to conduct business in Florida that is rated not-less-than Category A- :VII by A . M . Best , subject to approval by Indian River County's Risk Manager, of the following types and amounts of insurance : - 2 - 1 ( 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 , product/completed operations , contractual liability, and independent contractors ; (ii ) Business Auto Liability Insurance in an amount not less than $ 1 , 000 , 000 per occurrence combined single limit for bodily injury and property damage , including coverage for owned autos and other vehicles , hired autos and other vehicles , non -owned autos and other vehicles ; and (iii ) Worker's Compensation and Employer's Liability (current Florida statutory limit. ) . 5 . 6 . Insurance Administration . The insurance certificates , evidencing all required insurance coverages shall be fully acceptable to County in both form and content, and shall provide and specify that the related insurance coverage shall not be cancelled without at least thirty (30 ) calendar days prior written notice having been given the County. In addition , the County may request such other proofs and assurances as it may reasonable require that the insurance is and at all times remains in full force and effect. Recipient agrees that it is the Recipient's sole responsibility to coordinate activities among itself, the County, and the Recipient's insurer(s ) so that the insurance certificates are acceptable to and accepted by County within the time limits set forth in this Contract. The County shall be listed as an additional insured on all insurance coverage required by this Contract, except Worker's Compensation Insurance . The Recipient shall , upon ten ( 10 ) days prior written request from the County, deliver copies to the County, or make copies available for the County's inspection at Recipient's place of business , of any and all insurance policies that are required in this Contract. If the Recipient fails to deliver or make copies of the policies available to the County; fails to obtain replacement insurance or have previous insurance policies reinstated or renewed upon termination or cancellation of existing required coverages ; or fails in any other regard to obtain coverages sufficient to meet the terms and conditions of this Contract, then the County may, at its sole option , terminate this Contract. 5 . 7 , Indemnification . The Recipient shall indemnify and save harmless the County, its agents , officials , and employees from and against any and all claims , liabilities , losses , damage, or causes of action which may arise from any misconduct, negligent act, or omissions of the Recipient, its agents , officers , or employees in connection with the performance of this Contract. 5 . 8 . Public Records . The Recipient agrees to comply with the provisions of Chapter 119 , Florida Statutes (Public Records Law) in connection with this Contract. 6 , Termination , This Contract may be terminated by either party, without cause , upon thirty (30) days prior written notice to the other party. In addition , the County may terminate this Contract for convenience upon ten ( 10) days prior written notice to the Recipient if the County determines that such termination is in the public interest . 7 . Availability of Funds . The obligations of the County under this contract are subject to the availability of funds lawfully appropriated for its purpose by the Board of County Commissioners of Indian River County. 8 . Standard Terms . This Contract is subject to the standard terms attached hereto as Exhibit C and incorporated herein in its entirety by this reference . - 3 - IN WITNESS WHEREOF , County and Recipient have entered into this Contract on the date first above written . INDIAN RIVER COUNTY BOARD OF COMMISSIONERS By: Y 5. k ._--`--- Thomas S . Lowther, Chairman BCC Approved : ' - Q S ")o ld ' -- � . . d Atte Barton , Clerk Bl " Deputy Clerk , Approve , Jose h A . Baird County Administrator Approve to form and legal sufficiency: B Zi- M arian E . Fell , Assistant County Attor ey RECJW By: Boys & Girls Clubs of Indian River County, Inc. - 4 - 1 ( 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 , product/completed operations , contractual liability, and independent contractors ; (ii ) Business Auto Liability Insurance in an amount not less than $ 1 , 000 , 000 per occurrence combined single limit for bodily injury and property damage , including coverage for owned autos and other vehicles , hired autos and other vehicles , non -owned autos and other vehicles ; and (iii ) Worker's Compensation and Employer's Liability (current Florida statutory limit. ) . 5 . 6 . Insurance Administration . The insurance certificates , evidencing all required insurance coverages shall be fully acceptable to County in both form and content, and shall provide and specify that the related insurance coverage shall not be cancelled without at least thirty (30 ) calendar days prior written notice having been given the County. In addition , the County may request such other proofs and assurances as it may reasonable require that the insurance is and at all times remains in full force and effect. Recipient agrees that it is the Recipient's sole responsibility to coordinate activities among itself, the County, and the Recipient's insurer(s ) so that the insurance certificates are acceptable to and accepted by County within the time limits set forth in this Contract. The County shall be listed as an additional insured on all insurance coverage required by this Contract, except Worker's Compensation Insurance . The Recipient shall , upon ten ( 10 ) days prior written request from the County, deliver copies to the County, or make copies available for the County's inspection at Recipient's place of business , of any and all insurance policies that are required in this Contract. If the Recipient fails to deliver or make copies of the policies available to the County; fails to obtain replacement insurance or have previous insurance policies reinstated or renewed upon termination or cancellation of existing required coverages ; or fails in any other regard to obtain coverages sufficient to meet the terms and conditions of this Contract, then the County may, at its sole option , terminate this Contract. 5 . 7 , Indemnification . The Recipient shall indemnify and save harmless the County, its agents , officials , and employees from and against any and all claims , liabilities , losses , damage, or causes of action which may arise from any misconduct, negligent act, or omissions of the Recipient, its agents , officers , or employees in connection with the performance of this Contract. 5 . 8 . Public Records . The Recipient agrees to comply with the provisions of Chapter 119 , Florida Statutes (Public Records Law) in connection with this Contract. 6 , Termination , This Contract may be terminated by either party, without cause , upon thirty (30) days prior written notice to the other party. In addition , the County may terminate this Contract for convenience upon ten ( 10) days prior written notice to the Recipient if the County determines that such termination is in the public interest . 7 . Availability of Funds . The obligations of the County under this contract are subject to the availability of funds lawfully appropriated for its purpose by the Board of County Commissioners of Indian River County. 8 . Standard Terms . This Contract is subject to the standard terms attached hereto as Exhibit C and incorporated herein in its entirety by this reference . - 3 - EXHIBIT A (Copy of complete Request for Proposal ) EXHIBIT - A - Boys & Girls Club of Indian River County, Inc. — Sebastian Branch Grant Application to the Children's Services Advisory Committee PROGRAM COVER PAGE for 2005-2006 Organization Name : Boys & Girls Clubs of Indian River County Inc President & CEO : Ronnie Hewett E-mail : RHewett BGCghotmail com Address : P . O . Box 643068 Telephone : 772-299- 7449 Vero Beach, Florida 32964 Fax : 772-299-3840 Director of Operations : Parris Westbrook E-mail : ParrisBGCIRCgmsn com Address : P . O . Box 643068 Telephone : 772-299- 7449 Vero Beach, Florida 32964 Fax : 772-299-3840 Program, Titles Sebastian Branch Priority Need Area Addressed: Mental Wellness Issues & Childcare Access Brief Description of the Program:_Taxonomy Definition for Bovs/Girls Clubs - PS -980 . 1 Programs that provide a wide ranee of supervised recreational activities and delin uency prevention services for children and youth of all aces and backgrounds but particularly for disadvantaged youth through membership in bovs and/or girls clubs Club members are entitled to use recreational facilities and may have access to counseling tutorial services employment assistance an programs drnor abuse and alcoholism prevention and other activities and services that direct their energies toward positive social goals and facilitate healthy personality development SUMMARY REPORT — (Enter Information In The Black Cells Only) Amount Requested from Funder for 2005 / 06 : $ 352000 . 00 Total Proposed Program Budget for 2005 / 06 : $ 274 , 502 . 00 Percent of Total Program Budget : 12 . 8 % Current Funding ( 2004 / 05 ) : $ 30 , 000 . 00 Dollar increase / ( decrease ) in request : $ 5 , 000 . 00 IT ercent increase / ( decrease ) in request * * : 16 . 7 % Unduplicated umber o Children to a serve Individually : 575 nduplicated Number of Adults to be served Individually : 208 nduplicated Number to be served via Group settings : 110 ota Program Cost per Client : sssss's $ 301 10 7 . 39 * *If request increased 5 % or more, briefly explain why : We are requestine an increase because we will be moving into our new facility in late 2005 which means we will have the space to be able to serve additional kids per day. Additionally actual costs to offer basic services to members has increased over the vears e. g. program/educational supplies rent/mortgage utilities etc If these funds are being used to match another source, name the source and the $ amount : N/A , The Organization 's Board of Directors has approved this applicat on o (date). April 20, 2005 Jay McNamara Name of President/Chair of the Board afore Ronnie Hewett \ Name of Executive DirectoriCEO Signature 1 IN WITNESS WHEREOF , County and Recipient have entered into this Contract on the date first above written . INDIAN RIVER COUNTY BOARD OF COMMISSIONERS By: Y 5. k ._--`--- Thomas S . Lowther, Chairman BCC Approved : ' - Q S ")o ld ' -- � . . d Atte Barton , Clerk Bl " Deputy Clerk , Approve , Jose h A . Baird County Administrator Approve to form and legal sufficiency: B Zi- M arian E . Fell , Assistant County Attor ey RECJW By: Boys & Girls Clubs of Indian River County, Inc. - 4 - Boys & Girls Club of Indian River County, Inc. — Sebastian Branch Grant Application to the Children's Services Advisory Committee ORGANIZATION : Boys & Girls Clubs of Indian River County, Inc. PROGRAM: South County Branch TABLE OF CONTENTS for 2005-2006 Please "X" the parts of the grant application to indicate that they are included. Also, please put the page number where the information can be located. X Section of the Proposal Pnoroft X COVER PAGE (with signatures) . . . . . . . . . . 1 X TABLE OF CONTENTS (checklist) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 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) X1 . Funding priority . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 X 2 . Description of program activities . 6 X 3 . Evidence that program strategy will work , 6 X4 . Staffing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 X 5 . Awareness of program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . a . . . . . . . . . . . . . 7 X 6 . Accessibility of program . . , . . . . , . . . . Ole 900 * 04 * & soft 9 * 0 , 00 . . . . . . . . . . . . . . 7 X D. MEASURABLE OUTCOMES (two pages maximum) . . . . . . . . . . . . . . . . . . . . . . . . . . . . logo 8 X E. COLLABORATION (one page maximum) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 F. PROGRAM EVALUATION (two pages maximum) X1 . Demographics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 a a 0 1 0 a 0 0 0 1 a a 0 9 1 1 1 1111 11 X2 . Measures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 . . . . . . . . . . . . . . . . . . . . . . . . . X3 . Reporting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . : . . . 12 X G. TIMETABLE (one page maximum) 13 H. UNDUPLICATED CLIENT COUNT X 1 . Projections by Location . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 X 2 . Projections by Age Group . . . . . . . . . . . . . . . . . . . . . . 14 I. BUDGET FORMS X 1 . Financial Budget Farms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 2 Boys & Girls Club of Indian River County, Inc. — Sebastian Branch Grant Application to the Children's Services Advisory Committee J. FUNDER SPECIFIC/ADDITIONAL SHEETS (On White Paper) X 1 . List of current officers and directors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . J- 1 2 . Latest Financial Audit Report & Management Letter that conforms with the X AICPA Audit Guide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . a 6 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . J-2 X 3 . Most recent IRS Form 990, Including all schedules ' . 111 . # 1 116 , all 06 1 1 1 * 10 * 1 1 11 1 1 I ' ll J- 13 4 . Most recent Internal Financial Statement (i . e . : Balance Sheet and Operating XBudget) . . . . . . . . . 0 * 00eesseses 000 # 00 Sao " I * 1 , 10 , 61 , 91066 1 * to 64 , 00000 * 000 0 * 000 0000 0 * 0 * a 0 0 0000 J-36 X 5 . Staff Organizational Chart . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . J- 39 X 6 . 501 (C)(3 ) IRS Exemption Letter . . . . . . . . . . . 069 * 000 go@ 0 DOE 06 mpg . . . . 0 . . . . . . J-40 X 7 . Articles of Incorporation . . . . . . . . . * 0 * 068 be * 000 0 * 4 * 00 * * go , 0 0 , 0 . . . . . . . . . . . . . . . . . . J-41 X 8 . Agency ' s Bylaws . . . 0 4 6 a 6 1 1 1 1 1 a I 1 0 1 J- 50 X 9. Agency ' s written policy regarding Affirmative Action . J-64 X 10 . Parent & Member Surveys for South County and Sebastian . . J-65 X 11 . Parent & Member Surveys for YVC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . J-74 X 12 . Most Recent Annual Report. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . J-79 K. APPENDIX: Supporting Documentation X 1 . Not for profit agency certification . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . : . . K- 1 X 2. Indian River County Authorization for Release of Information . . . * , * * * * K-2 X 3 . Sworn Statement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . K-5 X 4 . Proof of Liability & Worker' s Compensation Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . K- 14 3 EXHIBIT A (Copy of complete Request for Proposal ) EXHIBIT - A - Boys & Girls Club of Indian River County, Inc. — Sebastian Branch Grant Application to the Children 's Services Advisory Committee PROPOSAL NARRATIVE A. ORGANIZATION CAPABILITY (Entire Section A not to exceed one page) 1 . Provide the mission statement and vision of your organization. Mission Statement : To inspire and enable all young people, especially those from disadvantaged circumstances to realize their full potential , as productive, responsible and caring citizens . Vision : To accomplish our mission by establishing neighborhood clubs and outreach services in Indian River County with quality prograrns and staff. 2. Provide a brief summary of your organization including areas of expertise, accomplishments, and population served. The Boys & Girls Clubs of Indian River County offers a diverse, affordable program to kids in a positive atmosphere . Our daily after-school and summer programs offered through our "Club" house locations and our outreach services provided through our Youth Volunteer Corps program allows us to provide services to children throughout Indian River County. These program activities attract and sustain young people, ages 6 through 18 , who pay a nominal annual membership fee of $35 . 00 (which includes a free Boys & Girls Club t-shirt) . Nowhere in Indian River County can kids or parents find such valuable services offered so inexpensively. While our method of program delivery may change with seasonal activities, or school related endeavors, the core of what and how we conduct daily activities remains much the same . The overall Boys & Girls Club program structure can be divided into "Five Core Service Areas" . Together, these core service areas provide a diverse base of activities designed to meet the needs and interests of every member. The following Five Core program areas represent the Club ' s service offerings to its membership : • Education and Career Development . . . enables youth to become proficient in basic educational disciplines, apply learning to everyday situations and embrace technology to achieve success in a career and life in general . • Character and Leadership Development . . . empowers youth to support and influence their Club and community, sustain meaningful relationships with others, develop a positive self- image, participate in the democratic process and respect their own and others ' cultural identities . • Health and Life Skills . . . develops young people ' s capacity to engage in positive behaviors that nurture their own well-being, set personal goals and live successfully as self- sufficient adults . • The Arts . . . enables youth to develop their creativity and cultural awareness through knowledge and appreciation of the visual arts, crafts, performing arts and creative writing . • Sports Fitness and Recreation . . . develops fitness, positive use of leisure time, skills for stress management, appreciation for the environment and social skills . 4 Boys & Girls Club of Indian River County, Inc. — Sebastian Branch Grant Application to the Children's Services Advisory Committee Be PROGRAM NEED STATEMENT (Entire Section B not to exceed one page) 1 . a) What is the unacceptable condition requiring change? b) Who has the need ? c) Where do they live? d) Provide local, state, or national trend data, with reference source, that corroborates that this is an area of need. a. Limited access to affordable after school and summer programs for children 6 — 18 years of age, low economics, juvenile crime and below average academic achievement is the condition requiring change. b. We define those in need as children between the ages of 6 years old that have completed kindergarten through 18 years of age, with a special interest in working with disadvantaged youth. We define disadvantaged youth as children from low economic status, one-parent families and latch key kids. C* Through our Sebastian Branch, located at 250 Sebastian Blvd, we mainly serve children who live within close proximity or who attend Sebastian Elementary, Pelican Island Elementary, Sebastian River Middle, Sebastian Charter Junior High and Sebastian River High School. d According to the Indian River County School District 47% of the children that attend Sebastian Elementary, Pelican Island Elementary and Sebastian River Middle School are listed as economically disadvantaged. Additionally, Sebastian River High School is considered a "C" rated school according to the Florida Comprehensive Assessment Test (FCAT) standards 2003 -2004. Indian River County statistics from the FL Department of Juvenile Justice Bureau of Data and research conclude that 10% (a 3% increase from 1999-2000 statistics) of all 10- 17 year olds have been referred to the juvenile justice System during 2001 -2002. 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. No other program in Indian River County offers a dedicated youth facility, like the Boys & Girls Club, for children 6- 18 years of age with year round drop in services Monday — Friday . For every child the Boys & Girls Clubs serves, our youth development activities are designed to build the following traits : • Positive self-identity. A healthy self-concept, a strong belief in one ' s self-worth, and a sense of hope about one ' s future . • Educational, employment, social, emotional and cultural competencies . The knowledge , skills, strategies and attitudes necessary to have a positive foundation for success . • Community and civic involvement. A sense of belonging to community, family and/or group ; willingness to take civic responsibility. • Health and well-being . Living a healthy lifestyle, taking part in regular fitness activities , able to access health care resources and engage in positive behaviors . • Moral compass . Youth have values enabling them to develop positive relationships with others . b. Our target population is underserved by other programs for the following reasons : affordability, accessibility and scope of services . 5 Boys & Girls Club of Indian River County, Inc. — Sebastian Branch Grant Application to the Children's Services Advisory Committee PROGRAM COVER PAGE for 2005-2006 Organization Name : Boys & Girls Clubs of Indian River County Inc President & CEO : Ronnie Hewett E-mail : RHewett BGCghotmail com Address : P . O . Box 643068 Telephone : 772-299- 7449 Vero Beach, Florida 32964 Fax : 772-299-3840 Director of Operations : Parris Westbrook E-mail : ParrisBGCIRCgmsn com Address : P . O . Box 643068 Telephone : 772-299- 7449 Vero Beach, Florida 32964 Fax : 772-299-3840 Program, Titles Sebastian Branch Priority Need Area Addressed: Mental Wellness Issues & Childcare Access Brief Description of the Program:_Taxonomy Definition for Bovs/Girls Clubs - PS -980 . 1 Programs that provide a wide ranee of supervised recreational activities and delin uency prevention services for children and youth of all aces and backgrounds but particularly for disadvantaged youth through membership in bovs and/or girls clubs Club members are entitled to use recreational facilities and may have access to counseling tutorial services employment assistance an programs drnor abuse and alcoholism prevention and other activities and services that direct their energies toward positive social goals and facilitate healthy personality development SUMMARY REPORT — (Enter Information In The Black Cells Only) Amount Requested from Funder for 2005 / 06 : $ 352000 . 00 Total Proposed Program Budget for 2005 / 06 : $ 274 , 502 . 00 Percent of Total Program Budget : 12 . 8 % Current Funding ( 2004 / 05 ) : $ 30 , 000 . 00 Dollar increase / ( decrease ) in request : $ 5 , 000 . 00 IT ercent increase / ( decrease ) in request * * : 16 . 7 % Unduplicated umber o Children to a serve Individually : 575 nduplicated Number of Adults to be served Individually : 208 nduplicated Number to be served via Group settings : 110 ota Program Cost per Client : sssss's $ 301 10 7 . 39 * *If request increased 5 % or more, briefly explain why : We are requestine an increase because we will be moving into our new facility in late 2005 which means we will have the space to be able to serve additional kids per day. Additionally actual costs to offer basic services to members has increased over the vears e. g. program/educational supplies rent/mortgage utilities etc If these funds are being used to match another source, name the source and the $ amount : N/A , The Organization 's Board of Directors has approved this applicat on o (date). April 20, 2005 Jay McNamara Name of President/Chair of the Board afore Ronnie Hewett \ Name of Executive DirectoriCEO Signature 1 Boys & Girls Club of Indian River County, Inc. — Sebastian Branch Grant Application to the Children 's Services Advisory Committee C. PROGRAM DESCRIPTION (Entire Section C, I — 6, not to exceed two pages) 1 . List Priority Needs area addressed. Mental Wellness Issues & Childcare Access 2 . Briefly describe program activities including location of services . Boys & Girls Club programs are designed to meet members' needs and provide them with a diverse range of activities that spark their interests, offering attractive alternatives to getting into trouble. They increase educational achievement, develop tolerance and build character. They are carefully researched, designed and field-tested They are continually assessed and evaluated so we know that they are working. Daily drop in hours are provided through our Sebastian Branch, located at 250 Sebastian Boulevard, Monday — Friday after school until 8 p.m. and during winter, spring and summer breaks from 8 am. to 6 p.m. Specific scheduled programs are offered in each of our five core area as follows: • CHARACTER AND LEADERSHIP DEVELOPMENT: Youth of the Year, TEENSupreme(V Keystone Clubs and Torch Clubs • EDUCATION AND CAREER DEVELOPMENT: Project Learn: The Educational Enhancement Program, Goals for Graduation, POWER HOUR, The Ultimate Journey, JOB READY! , Goals for Growth, Junior Staff Career Development, CareerLaunch, Skill Tech: A Club Tech Basic Skills Program • HEALTH AND LIFE SKILLS : SMART Moves (Skills Mastery and Resistance Training), SMART Leaders, Family Advocacy Network (FAN Club, SMART Girls, Passport to Manhood, Act SMART and Child Safety and Protection • THE ARTS : Fine Arts Exhibit Program, ImageMakers: National Photography Program • SPORTS, FITNESS AND RECREATION: FITNESS AUTHORITY® • SPECIALIZED PROGRAM INITIATIVES : The Diversity Initiative & Family Support progrxn. 3 . Briefly describe how your program addresses the stated need/problem. Describe how your program follows a recognized " best practice" (see definition on page 12 of the Instructions) and provide evidence that indicates proposed strategies are effective with target population. After-school programs keep kids safe, help working families and improve students' academic achievement by providing critical opportunities for youth to learn and grow. • Students in quality after-school programs have better academic performance, behavior and school attendance and greater expectations for the future (US Departments of Education and Justice, 2000). • Students who spend 1 - 4 hours per week in extracurricular activities are 51 percent less likely to have used drugs (Department of Health and Human Services, Adolescent Time Use, Risky Behavior and Outcomes: An Analysis of National Data. Wasllington D.C. , 1995). • After-school programs in high crime areas can cut by as much as 3/4 the high school student' s risk of becoming involved in crime. And being supervised after school cuts in half the risk that middle school kids will smoke, drink, or abuse drugs, and reduces teen pregnancy as well. (National Center for Juvenile Justice, OJJDP, Wash. , D.C. 199T) • The effectiveness of Boys & Girls Clubs has been proven repeatedly. A Louis Harris survey of Club alumni concluded that Clubs help young people grow into productive citizens . 6 Boys & Girls Club of Indian River County, Inc. — Sebastian Branch Grant Application to the Children 's Services Advisory Committee The survey revealed the firm conviction on the part of alumni that Club membership had a positive effect on their lives, provided the skills necessary for leadership, improved their relationships with others and influenced success in later life. • The Carnegie Corporation's report, A Matter of Time: Risk and Opportunity in the Non-School Hours, underscores the importance of community environment and institutions in contributing to the development of young people. The report emphasizes that the opportunity to make a positive contribution arises largely outside the structural academic environment. The report concludes that community-based youth development organizations such as Boys & Girls Clubs represent a valuable national resource with considerable untapped potential, 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 to the information in the Position Listing on the Budget Narrative Worksheet). 1 full-time Director of Operations — with a Bachelors Degree with a minimum of three years working in the non profit sector, dedicating 10 hours per week of his/her time in program support, evaluation & staff training for each club for a total of 20 hours per week of his/her time. 1 full-time Branch Director — with a Bachelors Degree with a minimum of three years experience working with youth, dedicating 40 hours per week of his/her time in planning, coordinating and directing the daily program at the Club as well as facility and personnel management. 1 full-time Program Director — with an Associates Degree or equivalent with a minimum of three years experience working with youth, dedicating 40 hours per week of his/her time in planning, coordinating and implementing the daily program at the Club. 6 part-time Programpecialists — with a High School Diploma, working towards a college degree with demonstrated capability in working positively with youth, dedicating 24 hours per week of his/her time in providing onsite supervision of Club members. Volunteers - Demonstrated capability in working positively with youth. As many as we can get, dedicating specialized program opportunities for Club members. 5. How will the target population be made aware of the program ? Since opening the doors of our Clubs we have had waiting lists in the hundreds. Word of mouth from Club members and their parents is our biggest method of informing our target audience about our program. As a means to attract the teen population, our staff distributes flyers and gives presentations throughout the middle and high schools to promote involvement in the Club program. 6. How will the program be accessible to target population (i. e. , location , transportation, hours of operation) ? Boys & Girls Clubs provide access to its members by locating Club House facilities within walking or bike riding distance, as well as through collaborations with the School District of Indian River County Transportation Department which provides bus transportation from Sebastian area schools everyday after school. Our school year hours are Monday — Friday immediately after school (usually 2 : 30 p.m. ) until 8 : 00 P.M. During the summer and non-school days, we are open from 8 am. until 6 p.m. 7 Boys & Girls Club of Indian River County, Inc. — Sebastian Branch Grant Application to the Children's Services Advisory Committee ORGANIZATION : Boys & Girls Clubs of Indian River County, Inc. PROGRAM: South County Branch TABLE OF CONTENTS for 2005-2006 Please "X" the parts of the grant application to indicate that they are included. Also, please put the page number where the information can be located. X Section of the Proposal Pnoroft X COVER PAGE (with signatures) . . . . . . . . . . 1 X TABLE OF CONTENTS (checklist) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 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) X1 . Funding priority . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 X 2 . Description of program activities . 6 X 3 . Evidence that program strategy will work , 6 X4 . Staffing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 X 5 . Awareness of program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . a . . . . . . . . . . . . . 7 X 6 . Accessibility of program . . , . . . . , . . . . Ole 900 * 04 * & soft 9 * 0 , 00 . . . . . . . . . . . . . . 7 X D. MEASURABLE OUTCOMES (two pages maximum) . . . . . . . . . . . . . . . . . . . . . . . . . . . . logo 8 X E. COLLABORATION (one page maximum) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 F. PROGRAM EVALUATION (two pages maximum) X1 . Demographics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 a a 0 1 0 a 0 0 0 1 a a 0 9 1 1 1 1111 11 X2 . Measures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 . . . . . . . . . . . . . . . . . . . . . . . . . X3 . Reporting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . : . . . 12 X G. TIMETABLE (one page maximum) 13 H. UNDUPLICATED CLIENT COUNT X 1 . Projections by Location . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 X 2 . Projections by Age Group . . . . . . . . . . . . . . . . . . . . . . 14 I. BUDGET FORMS X 1 . Financial Budget Farms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 2 Boys & Girls Club of Indian River County, Inc. — Sebastian Branch Grant Application to the Children's Services Advisory Committee J. FUNDER SPECIFIC/ADDITIONAL SHEETS (On White Paper) X 1 . List of current officers and directors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . J- 1 2 . Latest Financial Audit Report & Management Letter that conforms with the X AICPA Audit Guide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . a 6 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . J-2 X 3 . Most recent IRS Form 990, Including all schedules ' . 111 . # 1 116 , all 06 1 1 1 * 10 * 1 1 11 1 1 I ' ll J- 13 4 . Most recent Internal Financial Statement (i . e . : Balance Sheet and Operating XBudget) . . . . . . . . . 0 * 00eesseses 000 # 00 Sao " I * 1 , 10 , 61 , 91066 1 * to 64 , 00000 * 000 0 * 000 0000 0 * 0 * a 0 0 0000 J-36 X 5 . Staff Organizational Chart . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . J- 39 X 6 . 501 (C)(3 ) IRS Exemption Letter . . . . . . . . . . . 069 * 000 go@ 0 DOE 06 mpg . . . . 0 . . . . . . J-40 X 7 . Articles of Incorporation . . . . . . . . . * 0 * 068 be * 000 0 * 4 * 00 * * go , 0 0 , 0 . . . . . . . . . . . . . . . . . . J-41 X 8 . Agency ' s Bylaws . . . 0 4 6 a 6 1 1 1 1 1 a I 1 0 1 J- 50 X 9. Agency ' s written policy regarding Affirmative Action . J-64 X 10 . Parent & Member Surveys for South County and Sebastian . . J-65 X 11 . Parent & Member Surveys for YVC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . J-74 X 12 . Most Recent Annual Report. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . J-79 K. APPENDIX: Supporting Documentation X 1 . Not for profit agency certification . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . : . . K- 1 X 2. Indian River County Authorization for Release of Information . . . * , * * * * K-2 X 3 . Sworn Statement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . K-5 X 4 . Proof of Liability & Worker' s Compensation Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . K- 14 3 Boys & Girls Club of Indian River County, Inc. — Sebastian Branch Grant Application to the Children 's Services Advisory Committee D. MEASURABLE OUTCOMES (Section D not to exceed two pages) OUTCOMES ACTIVITIES List all of the elements or the Measurable Outcomes List the tasks to accomplish the Outcome(s) 1 . To increase our average daily attendance of • Distribute Membership Recruitment Flyers in Sebastian Branch Club members 30% (From the schools to announce after school program in 70 to 100) as reported by the 2005-2006 year end the beginning of the school year and summer average daily attendance totals. Baseline: 2004- programs at end of the school year. 2005 average daily attendance totals. • Offer an annual membership fee of $35 .00. • Provide transportation after school through Indian River County School District to the Boys & Girls Club. • Opening a new 6500 sq. ft. facility in late 2005 in Sebastian. 2 . To maintain juvenile crime rates of enrolled • Provide daily diversion activities at the Club to 10 - 17 year old Club Members to less than channel youth energies into a positive direction. 3 % compared to non-club members which is Games room tournaments and out door 10% as reported by the 2001 -2002 juvenile playground activities will be offerd to initially arrests. Baseline : 2001 -2002 Indian River spark members interest. Once a rapport is built County statistics from the FL Department of with our members, staff will encourage Juvenile Justice Bureau Data. ( 10% of all participation within our five core program 10- 17 year olds) referred to the juvenile service area justice system. • Nominate eligible, deserving 14 year olds as Youth of the Month Nominees will be requested to complete a nomination form to be judged to determine the organizations Youth of the Year. • Maintain a Keystone Club for members 14 — 18 years that will meet a minimum of once a week. • Maintain a Torch Club for 11 - 13 year olds that will meet a minimum of once a week • Continue a Passport to Manhood program for 11 year old boys & up that will meet once a week for 8 weeks. • Continue the SMART Moves program for all age groups that will be offered on a weekly basis. • Continue a SMART Girls program that will be - offered weekly, for girls ages 10- 15 . The program is designed to encourage healthy attitudes that will enable early adolescent girls to develop to their full potential. • Continue a Child Safety & Protection Program that will meet once a week for 8 weeks. • Continue a violence prevention program that meet i o11C1:: a fo: 17 Nvee - U; coflibol atim g Boys & Girls Club of Indian River County, Inc. — Sebastian Branch Grant Application to the Children 's Services Advisory Committee with Safe Space. • Continue an anger management and conflict resolution program that meets once a week for 8 weeks in collaboration with Safe Space. 3 . Increase/improve grade and skill levels of nc . Provide daily Homework Help, Reading & less than 65 % of Club members Math skills enhancement activities, One-On- participating in its Power Hour program by One and Group Tutoring, POWER Pages and June 30, 2006 . Baseline : 1St quarter school POWER Point activities during the school year. grades compared to 3rd or 4th quarter grades . . Continue good grades parties quarterly to celebrate improvements in school performance. • Meet with school officials to identify those members who are failing and provide additional homework and tutoring support. • Continue a peer leader homework and tutoring program 5 days a week during the school year. • Continue a Goals for Graduation program that meets one a week for 12 weeks. • Continue a Goals for Growth program that meets once a week for 8 weeks. • Continue a Job Ready program that will be offered during the summer. • Continue a Career Launch program that will be offered year round to teenagers accessing the web at the Boys & Girls Club. • Provide daily access to computers to improve technology competency levels. 4 . Maintain 100% involvement of Club • Maintain a Family Support program, which is members ' parents (208) as reported by the designed to provide seasonal activities, events 2005 -2006 Parent attendance at Club events . and services designed to strengthen family Baseline : 2004-2005 Parents attendance at relations through informal social support. Club. • Maintain a Family Advisory Network (FAN Club) that will meet 4 times a year. • Distribute Parent Surveys once a year to evaluate quality of program and to determine other service areas to offer. 9 Boys & Girls Club of Indian River County, Inc. — Sebastian Branch Grant Application to the Children 's Services Advisory Committee PROPOSAL NARRATIVE A. ORGANIZATION CAPABILITY (Entire Section A not to exceed one page) 1 . Provide the mission statement and vision of your organization. Mission Statement : To inspire and enable all young people, especially those from disadvantaged circumstances to realize their full potential , as productive, responsible and caring citizens . Vision : To accomplish our mission by establishing neighborhood clubs and outreach services in Indian River County with quality prograrns and staff. 2. Provide a brief summary of your organization including areas of expertise, accomplishments, and population served. The Boys & Girls Clubs of Indian River County offers a diverse, affordable program to kids in a positive atmosphere . Our daily after-school and summer programs offered through our "Club" house locations and our outreach services provided through our Youth Volunteer Corps program allows us to provide services to children throughout Indian River County. These program activities attract and sustain young people, ages 6 through 18 , who pay a nominal annual membership fee of $35 . 00 (which includes a free Boys & Girls Club t-shirt) . Nowhere in Indian River County can kids or parents find such valuable services offered so inexpensively. While our method of program delivery may change with seasonal activities, or school related endeavors, the core of what and how we conduct daily activities remains much the same . The overall Boys & Girls Club program structure can be divided into "Five Core Service Areas" . Together, these core service areas provide a diverse base of activities designed to meet the needs and interests of every member. The following Five Core program areas represent the Club ' s service offerings to its membership : • Education and Career Development . . . enables youth to become proficient in basic educational disciplines, apply learning to everyday situations and embrace technology to achieve success in a career and life in general . • Character and Leadership Development . . . empowers youth to support and influence their Club and community, sustain meaningful relationships with others, develop a positive self- image, participate in the democratic process and respect their own and others ' cultural identities . • Health and Life Skills . . . develops young people ' s capacity to engage in positive behaviors that nurture their own well-being, set personal goals and live successfully as self- sufficient adults . • The Arts . . . enables youth to develop their creativity and cultural awareness through knowledge and appreciation of the visual arts, crafts, performing arts and creative writing . • Sports Fitness and Recreation . . . develops fitness, positive use of leisure time, skills for stress management, appreciation for the environment and social skills . 4 Boys & Girls Club of Indian River County, Inc. — Sebastian Branch Grant Application to the Children's Services Advisory Committee Be PROGRAM NEED STATEMENT (Entire Section B not to exceed one page) 1 . a) What is the unacceptable condition requiring change? b) Who has the need ? c) Where do they live? d) Provide local, state, or national trend data, with reference source, that corroborates that this is an area of need. a. Limited access to affordable after school and summer programs for children 6 — 18 years of age, low economics, juvenile crime and below average academic achievement is the condition requiring change. b. We define those in need as children between the ages of 6 years old that have completed kindergarten through 18 years of age, with a special interest in working with disadvantaged youth. We define disadvantaged youth as children from low economic status, one-parent families and latch key kids. C* Through our Sebastian Branch, located at 250 Sebastian Blvd, we mainly serve children who live within close proximity or who attend Sebastian Elementary, Pelican Island Elementary, Sebastian River Middle, Sebastian Charter Junior High and Sebastian River High School. d According to the Indian River County School District 47% of the children that attend Sebastian Elementary, Pelican Island Elementary and Sebastian River Middle School are listed as economically disadvantaged. Additionally, Sebastian River High School is considered a "C" rated school according to the Florida Comprehensive Assessment Test (FCAT) standards 2003 -2004. Indian River County statistics from the FL Department of Juvenile Justice Bureau of Data and research conclude that 10% (a 3% increase from 1999-2000 statistics) of all 10- 17 year olds have been referred to the juvenile justice System during 2001 -2002. 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. No other program in Indian River County offers a dedicated youth facility, like the Boys & Girls Club, for children 6- 18 years of age with year round drop in services Monday — Friday . For every child the Boys & Girls Clubs serves, our youth development activities are designed to build the following traits : • Positive self-identity. A healthy self-concept, a strong belief in one ' s self-worth, and a sense of hope about one ' s future . • Educational, employment, social, emotional and cultural competencies . The knowledge , skills, strategies and attitudes necessary to have a positive foundation for success . • Community and civic involvement. A sense of belonging to community, family and/or group ; willingness to take civic responsibility. • Health and well-being . Living a healthy lifestyle, taking part in regular fitness activities , able to access health care resources and engage in positive behaviors . • Moral compass . Youth have values enabling them to develop positive relationships with others . b. Our target population is underserved by other programs for the following reasons : affordability, accessibility and scope of services . 5 Boys & Girls Club of Indian River County, Inc. — Sebastian Branch Grant Application to the Children ' s Services Advisory Committee E. COLLABORATION (Entire Section E not to exceed one page) 1 . List your program ' s collaborative partners and the resources that they are providing to the program beyond referrals and support. Collaborative Agency Resources provided to the program Indian River County School District Transportation after school from Thompson Elementary and Oslo Middle School as well as Sebastian area schools to the Boys & Girls Club . After school snacks and summer lunch program. Homeless Family Center Offer scholarships to children of homeless families, provide computer lab access to children (through programs offered to Club members) and parents/guardians (in the evenings to teach computer skills and help with resumes and job placement services) . Art instruction, supplies, place to host exhibits and Center for the Arts museum in the basket series. Coordinate mentoring opportunities and encourage Youth Guidance Youth Guidance participants to become members of the Boys & Girls Club and promote Mentor and Mentees to meet at the Boys & Girls Club . Provide instructors to conduct conflict resolution, Safe Space domestic violence and anger management sessions . Department of Juvenile Justice Will match members with juvenile arrest to help us determine the percentage of our members participating in juvenile crime . Volunteers to conduct troops at the B &G Club once a Girl Scouts week. 10 Boys & Girls Club of Indian River County, Inc. — Sebastian Branch Grant Application to the Children's Services Advisory Committee 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 111 ? Each participant will be required to fill out a membership application that is manually entered into a computer software program called "Member Tracking", which allows us to electronically maintain a database on each member that includes demographic, age, gender, race, family economics , daily attendance, and activities in which they participated . Our target population is tracked by age . We are able to track our special interest in serving disadvantaged youth by asking and collecting the following : • Does your child receive free or reduced lunch? (Asked to determine low economics) . Who does your child live with? (Asked to determine single parent family status) . • We collect report grades on a quarterly basis . • Parent surveys will help us to gather information on their child ' s involvement, if any, with the Juvenile . Justice system. • We are in the process of establishing a relationship with our local Department of Juvenile Justice so that we may submit our membership list to them to determine any Juvenile arrests of members . Limited -access to affordable after school programs for children 6 - 18 years of age , low economics , juvenile crime and below average academic achievement is the condition requiring , change, 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? • Membership Applications are collected upon registering for the program. Membership renewal applications are updated continuously throughout the year, with the bulk registering at the beginning of the school year. • Daily average attendance is collected by recording the number of members that attend daily divided by the numbers of days of service . Results are maintained and available on a monthly basis . • Club Activities are collected daily to track members ' participation in the various activities that are offered throughout the day. • Juvenile Crime Rates will be collected by providing the Department of Juvenile Justice with the names of all children enrolled in the program; they will then notify us regarding the number of members arrested. Comparisons can be ran on a quarterly basis . And through Parent Sun'eys . 11 Boys & Girls Club of Indian River County, Inc. — Sebastian Branch Grant Application to the Children 's Services Advisory Committee C. PROGRAM DESCRIPTION (Entire Section C, I — 6, not to exceed two pages) 1 . List Priority Needs area addressed. Mental Wellness Issues & Childcare Access 2 . Briefly describe program activities including location of services . Boys & Girls Club programs are designed to meet members' needs and provide them with a diverse range of activities that spark their interests, offering attractive alternatives to getting into trouble. They increase educational achievement, develop tolerance and build character. They are carefully researched, designed and field-tested They are continually assessed and evaluated so we know that they are working. Daily drop in hours are provided through our Sebastian Branch, located at 250 Sebastian Boulevard, Monday — Friday after school until 8 p.m. and during winter, spring and summer breaks from 8 am. to 6 p.m. Specific scheduled programs are offered in each of our five core area as follows: • CHARACTER AND LEADERSHIP DEVELOPMENT: Youth of the Year, TEENSupreme(V Keystone Clubs and Torch Clubs • EDUCATION AND CAREER DEVELOPMENT: Project Learn: The Educational Enhancement Program, Goals for Graduation, POWER HOUR, The Ultimate Journey, JOB READY! , Goals for Growth, Junior Staff Career Development, CareerLaunch, Skill Tech: A Club Tech Basic Skills Program • HEALTH AND LIFE SKILLS : SMART Moves (Skills Mastery and Resistance Training), SMART Leaders, Family Advocacy Network (FAN Club, SMART Girls, Passport to Manhood, Act SMART and Child Safety and Protection • THE ARTS : Fine Arts Exhibit Program, ImageMakers: National Photography Program • SPORTS, FITNESS AND RECREATION: FITNESS AUTHORITY® • SPECIALIZED PROGRAM INITIATIVES : The Diversity Initiative & Family Support progrxn. 3 . Briefly describe how your program addresses the stated need/problem. Describe how your program follows a recognized " best practice" (see definition on page 12 of the Instructions) and provide evidence that indicates proposed strategies are effective with target population. After-school programs keep kids safe, help working families and improve students' academic achievement by providing critical opportunities for youth to learn and grow. • Students in quality after-school programs have better academic performance, behavior and school attendance and greater expectations for the future (US Departments of Education and Justice, 2000). • Students who spend 1 - 4 hours per week in extracurricular activities are 51 percent less likely to have used drugs (Department of Health and Human Services, Adolescent Time Use, Risky Behavior and Outcomes: An Analysis of National Data. Wasllington D.C. , 1995). • After-school programs in high crime areas can cut by as much as 3/4 the high school student' s risk of becoming involved in crime. And being supervised after school cuts in half the risk that middle school kids will smoke, drink, or abuse drugs, and reduces teen pregnancy as well. (National Center for Juvenile Justice, OJJDP, Wash. , D.C. 199T) • The effectiveness of Boys & Girls Clubs has been proven repeatedly. A Louis Harris survey of Club alumni concluded that Clubs help young people grow into productive citizens . 6 Boys & Girls Club of Indian River County, Inc. — Sebastian Branch Grant Application to the Children 's Services Advisory Committee The survey revealed the firm conviction on the part of alumni that Club membership had a positive effect on their lives, provided the skills necessary for leadership, improved their relationships with others and influenced success in later life. • The Carnegie Corporation's report, A Matter of Time: Risk and Opportunity in the Non-School Hours, underscores the importance of community environment and institutions in contributing to the development of young people. The report emphasizes that the opportunity to make a positive contribution arises largely outside the structural academic environment. The report concludes that community-based youth development organizations such as Boys & Girls Clubs represent a valuable national resource with considerable untapped potential, 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 to the information in the Position Listing on the Budget Narrative Worksheet). 1 full-time Director of Operations — with a Bachelors Degree with a minimum of three years working in the non profit sector, dedicating 10 hours per week of his/her time in program support, evaluation & staff training for each club for a total of 20 hours per week of his/her time. 1 full-time Branch Director — with a Bachelors Degree with a minimum of three years experience working with youth, dedicating 40 hours per week of his/her time in planning, coordinating and directing the daily program at the Club as well as facility and personnel management. 1 full-time Program Director — with an Associates Degree or equivalent with a minimum of three years experience working with youth, dedicating 40 hours per week of his/her time in planning, coordinating and implementing the daily program at the Club. 6 part-time Programpecialists — with a High School Diploma, working towards a college degree with demonstrated capability in working positively with youth, dedicating 24 hours per week of his/her time in providing onsite supervision of Club members. Volunteers - Demonstrated capability in working positively with youth. As many as we can get, dedicating specialized program opportunities for Club members. 5. How will the target population be made aware of the program ? Since opening the doors of our Clubs we have had waiting lists in the hundreds. Word of mouth from Club members and their parents is our biggest method of informing our target audience about our program. As a means to attract the teen population, our staff distributes flyers and gives presentations throughout the middle and high schools to promote involvement in the Club program. 6. How will the program be accessible to target population (i. e. , location , transportation, hours of operation) ? Boys & Girls Clubs provide access to its members by locating Club House facilities within walking or bike riding distance, as well as through collaborations with the School District of Indian River County Transportation Department which provides bus transportation from Sebastian area schools everyday after school. Our school year hours are Monday — Friday immediately after school (usually 2 : 30 p.m. ) until 8 : 00 P.M. During the summer and non-school days, we are open from 8 am. until 6 p.m. 7 Boys & Girls Club of Indian River County, Inc. — Sebastian Branch Grant Application to the Children's Services Advisory Committee • School Achievement will be measured by collecting report card data and providing a comparison of grades from quarter to quarter. A baseline will be established the 1St quarter of each year and compared to results at the end of the year. • Parent Surveys * will be distributed to each parent in May to evaluate services being ` delivered. • Member Surveys * will be distributed to each member twice per year to determine the impact the Club has had on them individually. * Copies of the surveys are attached to this grant application . 1 . 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? All data collected will be compiled and presented to all funders and contributors in order to present our agencies positive impact on the community. We will use the information gathered as a result of our measures to continuously update and improve our program to ensure it meets the needs of our members . 12 Boys & Girls Club of Indian River County, Inc. — Sebastian Branch Grant Application to the Children's Services Advisory Committee G. TIMETABLE (Section G not to exceed one page) 1 . List the major action steps, activities or cycles of events that will occur within the program year. New programs should include any start-up planning that may occur outside the funding year. In completing the timetable, review information detailed in prior sections . Month/Period Activities January 2005 Develop Program Budget for February Approval March 2005 Write and Prepare United Way Grant May 2005 Distribute Parent & Members Surveys May 2005 Develop Summer Program Schedule that incorporates all the National Programs mentioned in section C3 . May 2005 Write, Prepare and Submit Children ' s Services Advisory Committee Grant May 31 - June 3 , 2005 Summer staff training & Building Maintenance June b, 2005 1 St Day of Summer Program offers hours Monday — Friday 8 a. m. — 6 p .m . August 2005 Develop School Year 2005 -2006 Program Schedule that incorporates all the National Programs mentioned in section C3 . August 15 — 19, 2005 School Year Staff training and Building Maintenance November, February, May, August. Evaluate Boys & Girls Club Program Utilizing Commitment to Quality 4 times a year . 13 Boys & Girls Club of Indian River County, Inc. — Sebastian Branch Grant Application to the Children 's Services Advisory Committee D. MEASURABLE OUTCOMES (Section D not to exceed two pages) OUTCOMES ACTIVITIES List all of the elements or the Measurable Outcomes List the tasks to accomplish the Outcome(s) 1 . To increase our average daily attendance of • Distribute Membership Recruitment Flyers in Sebastian Branch Club members 30% (From the schools to announce after school program in 70 to 100) as reported by the 2005-2006 year end the beginning of the school year and summer average daily attendance totals. Baseline: 2004- programs at end of the school year. 2005 average daily attendance totals. • Offer an annual membership fee of $35 .00. • Provide transportation after school through Indian River County School District to the Boys & Girls Club. • Opening a new 6500 sq. ft. facility in late 2005 in Sebastian. 2 . To maintain juvenile crime rates of enrolled • Provide daily diversion activities at the Club to 10 - 17 year old Club Members to less than channel youth energies into a positive direction. 3 % compared to non-club members which is Games room tournaments and out door 10% as reported by the 2001 -2002 juvenile playground activities will be offerd to initially arrests. Baseline : 2001 -2002 Indian River spark members interest. Once a rapport is built County statistics from the FL Department of with our members, staff will encourage Juvenile Justice Bureau Data. ( 10% of all participation within our five core program 10- 17 year olds) referred to the juvenile service area justice system. • Nominate eligible, deserving 14 year olds as Youth of the Month Nominees will be requested to complete a nomination form to be judged to determine the organizations Youth of the Year. • Maintain a Keystone Club for members 14 — 18 years that will meet a minimum of once a week. • Maintain a Torch Club for 11 - 13 year olds that will meet a minimum of once a week • Continue a Passport to Manhood program for 11 year old boys & up that will meet once a week for 8 weeks. • Continue the SMART Moves program for all age groups that will be offered on a weekly basis. • Continue a SMART Girls program that will be - offered weekly, for girls ages 10- 15 . The program is designed to encourage healthy attitudes that will enable early adolescent girls to develop to their full potential. • Continue a Child Safety & Protection Program that will meet once a week for 8 weeks. • Continue a violence prevention program that meet i o11C1:: a fo: 17 Nvee - U; coflibol atim g Boys & Girls Club of Indian River County, Inc. — Sebastian Branch Grant Application to the Children 's Services Advisory Committee with Safe Space. • Continue an anger management and conflict resolution program that meets once a week for 8 weeks in collaboration with Safe Space. 3 . Increase/improve grade and skill levels of nc . Provide daily Homework Help, Reading & less than 65 % of Club members Math skills enhancement activities, One-On- participating in its Power Hour program by One and Group Tutoring, POWER Pages and June 30, 2006 . Baseline : 1St quarter school POWER Point activities during the school year. grades compared to 3rd or 4th quarter grades . . Continue good grades parties quarterly to celebrate improvements in school performance. • Meet with school officials to identify those members who are failing and provide additional homework and tutoring support. • Continue a peer leader homework and tutoring program 5 days a week during the school year. • Continue a Goals for Graduation program that meets one a week for 12 weeks. • Continue a Goals for Growth program that meets once a week for 8 weeks. • Continue a Job Ready program that will be offered during the summer. • Continue a Career Launch program that will be offered year round to teenagers accessing the web at the Boys & Girls Club. • Provide daily access to computers to improve technology competency levels. 4 . Maintain 100% involvement of Club • Maintain a Family Support program, which is members ' parents (208) as reported by the designed to provide seasonal activities, events 2005 -2006 Parent attendance at Club events . and services designed to strengthen family Baseline : 2004-2005 Parents attendance at relations through informal social support. Club. • Maintain a Family Advisory Network (FAN Club) that will meet 4 times a year. • Distribute Parent Surveys once a year to evaluate quality of program and to determine other service areas to offer. 9 Number of i ys � y n Budget 2004/05 � 1 M. , , Hobe Sound 011141116 1 a lulls 1 1 1 ■ s Port Saint Co.� Total St. Lucie •1 i .1. _ , Ii 11 _ I tell V41 W44 51 FIN D) I 1253 � l� , �t e b 4 S id �k v^ i �a'"'EE F � ( ��4° 4� ,.,a ' Fiscal � �-�. � i n a t gg yy1 Budget � � � � 1 P o o 1IlIff MA ILI"016 Total Children 19 to / ® � ® 1LAdu • 1 TotalI , a i Boys & Gins Clubs of Indian River County, Inc. - Sebastian Branch Grant Application to the Children's Services Advisory Committee UNIFORM GRANT APPLICATION BUDGET NARRATIVE WORKSHEET IMPORTANT: The Budget Narrative should provide details to justify the amount requested in each line item of the budget for your program. From this worksheet, your figures will be linked to the Total Agency Budget, Total Program Budget and Funder Specific Budget Forms. AGENCY/PROGRAM NAME : Boys & Girls Clubs of Indian River County - Sebastian Branch FUNDER : Children 's Services Advisory Committee CAUTION : Do not enter any figures where a cell is colored in dark blue - Formulas and/or links are in place. Gray areas should abe used for providing information. and calculations only. � �Ir�r 5e �c rKs foal �igency g rt3 utatg Budget .. u. _ . . . ,u . < . . .. .. , Mail Win nw� 1 Children's Services Council-St Lucie 0.00 0 . 00 2 Children's Services Council-Martin 0 .00 0 . 00 3 Advisory Committee-Indian River 35 , 000 .00 35, 000.00 1059000 . 00 4 United Way-St Lucie County 0.00 0 . 00 5 United Way-Martin County 0 .00 0. 00 6 United Way-Indian River County 55 , 000. 00 150, 000 .00 7 Department of-Children & Families 0.00 0 . 00 8 County Funds 0.00 0 . 00 9 Contributions-Cash 0. 00 283 , 875 .00 10 Program Fees 41250 . 00 81000 . 00 11 Fund Raising Events-Net 21500 . 00 117 , 900 . 00 12 Sales to Public - Net 0 . 00 0 . 00 13 Membership Dues 10,500.00 18 , 000. 00 14 Investment Income 0.00 0. 00 15 Miscellaneous 0.00 0 . 00 16 Le acies & Bequests 0.00 0 . 00 17 Funds from Other Sources 82 , 747 .00 207 ,684 . 00 18. Reserve Funds Used for Operating 0 .00 0. 00 19 in-Kind Donations (Not included in total) 0 .00 129000. 00 20 TOTAL REVENUES (doesn't Include line 19) $ 189 ,997. 00 1 $35 , 000 . 00 $890 ,459 . 00 ? = tDu R7 v : Int i Of i A eNc � s � B. r~x�l Vit_ as a 21 Salaries - (must complete chart on next page) 140,077 . 00 30 ,000 . 00 495 , 838 . 00 22 :FICA`- Total salaries x 0. 0765 10 , 716 .00 11912 . 50 37 , 932 . 00 Retiremennnual pension or qua 1 le 23 staff 41200 . 00 0 .00 26 , 250. 00 09`145aa Ica en a O - erm 24 Disab. 81164 . 00 31087 . 50 42 , 989 . 00 Workers Compensation - # employees x 25 rate 31754 .00 0 . 00 13 , 288 . 00 Florida Unemployment - # projected 26 employees x $7, 000 x UCT-6 rate 11042 . 00 0 . 001 3 , 969 . 00 5/16/2003 15 Boys & Girls Club of Indian River County, Inc. — Sebastian Branch Grant Application to the Children ' s Services Advisory Committee E. COLLABORATION (Entire Section E not to exceed one page) 1 . List your program ' s collaborative partners and the resources that they are providing to the program beyond referrals and support. Collaborative Agency Resources provided to the program Indian River County School District Transportation after school from Thompson Elementary and Oslo Middle School as well as Sebastian area schools to the Boys & Girls Club . After school snacks and summer lunch program. Homeless Family Center Offer scholarships to children of homeless families, provide computer lab access to children (through programs offered to Club members) and parents/guardians (in the evenings to teach computer skills and help with resumes and job placement services) . Art instruction, supplies, place to host exhibits and Center for the Arts museum in the basket series. Coordinate mentoring opportunities and encourage Youth Guidance Youth Guidance participants to become members of the Boys & Girls Club and promote Mentor and Mentees to meet at the Boys & Girls Club . Provide instructors to conduct conflict resolution, Safe Space domestic violence and anger management sessions . Department of Juvenile Justice Will match members with juvenile arrest to help us determine the percentage of our members participating in juvenile crime . Volunteers to conduct troops at the B &G Club once a Girl Scouts week. 10 Boys & Girls Club of Indian River County, Inc. — Sebastian Branch Grant Application to the Children's Services Advisory Committee 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 111 ? Each participant will be required to fill out a membership application that is manually entered into a computer software program called "Member Tracking", which allows us to electronically maintain a database on each member that includes demographic, age, gender, race, family economics , daily attendance, and activities in which they participated . Our target population is tracked by age . We are able to track our special interest in serving disadvantaged youth by asking and collecting the following : • Does your child receive free or reduced lunch? (Asked to determine low economics) . Who does your child live with? (Asked to determine single parent family status) . • We collect report grades on a quarterly basis . • Parent surveys will help us to gather information on their child ' s involvement, if any, with the Juvenile . Justice system. • We are in the process of establishing a relationship with our local Department of Juvenile Justice so that we may submit our membership list to them to determine any Juvenile arrests of members . Limited -access to affordable after school programs for children 6 - 18 years of age , low economics , juvenile crime and below average academic achievement is the condition requiring , change, 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? • Membership Applications are collected upon registering for the program. Membership renewal applications are updated continuously throughout the year, with the bulk registering at the beginning of the school year. • Daily average attendance is collected by recording the number of members that attend daily divided by the numbers of days of service . Results are maintained and available on a monthly basis . • Club Activities are collected daily to track members ' participation in the various activities that are offered throughout the day. • Juvenile Crime Rates will be collected by providing the Department of Juvenile Justice with the names of all children enrolled in the program; they will then notify us regarding the number of members arrested. Comparisons can be ran on a quarterly basis . 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" '' .., ,=6,a u. ���€; E . .r E eI;�a a : f : iry � sWa. �p,�i3� i.£u a. _ fir?`!' ` €est E`% t . . £.:, y�. . "! ���a"a „4 : ",y � >,j . y . rs„. E.� „ + . i( ns ; .n,' z1:. '1 � . E B I , 1 , , ' E'., x F z �,�' �. [g EW x;: !� u i ;«a e ,-` n a#2 , -�' �€`, , ., e yNs EF �€ E.�; .< . o ?�' : 3� r m S •' ?1p., .6, ,. i E % ln ,: _ ` sq ke+9 s E u I h SF . 'n`, j ve .. W -'afssf w , °. Ei i;.` ,l4�`s ” ," t r EIE "-' -'? `� i E � _. , �& �1 tL C SIE $ �. C 3 ' l ,I I'l C 3`+C7E " . : G ., �. 6 6g 1 - 1 n 1, �E F" C m a � O a cm p a c � � N ;rt " i CIIIm C w O ii I I m CL m 3 G m v , F>- . . . . . ° E d m pm ' m w W � °•> m R m� m 3 >O d j °1w 11I�e h O A O mmN M a} N Co ti O N N N 0 M M M M 0 0 M M Boys & Girls Club of Indian River County, Inc. — Sebastian Branch Grant Application to the Children's Services Advisory Committee • School Achievement will be measured by collecting report card data and providing a comparison of grades from quarter to quarter. A baseline will be established the 1St quarter of each year and compared to results at the end of the year. • Parent Surveys * will be distributed to each parent in May to evaluate services being ` delivered. • Member Surveys * will be distributed to each member twice per year to determine the impact the Club has had on them individually. * Copies of the surveys are attached to this grant application . 1 . 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? All data collected will be compiled and presented to all funders and contributors in order to present our agencies positive impact on the community. We will use the information gathered as a result of our measures to continuously update and improve our program to ensure it meets the needs of our members . 12 Boys & Girls Club of Indian River County, Inc. — Sebastian Branch Grant Application to the Children's Services Advisory Committee G. TIMETABLE (Section G not to exceed one page) 1 . List the major action steps, activities or cycles of events that will occur within the program year. New programs should include any start-up planning that may occur outside the funding year. In completing the timetable, review information detailed in prior sections . Month/Period Activities January 2005 Develop Program Budget for February Approval March 2005 Write and Prepare United Way Grant May 2005 Distribute Parent & Members Surveys May 2005 Develop Summer Program Schedule that incorporates all the National Programs mentioned in section C3 . May 2005 Write, Prepare and Submit Children ' s Services Advisory Committee Grant May 31 - June 3 , 2005 Summer staff training & Building Maintenance June b, 2005 1 St Day of Summer Program offers hours Monday — Friday 8 a. m. — 6 p .m . August 2005 Develop School Year 2005 -2006 Program Schedule that incorporates all the National Programs mentioned in section C3 . August 15 — 19, 2005 School Year Staff training and Building Maintenance November, February, May, August. Evaluate Boys & Girls Club Program Utilizing Commitment to Quality 4 times a year . 13 000 0 0 o00o o 0 0 0 o . . o 1 A 0 0 0 O ON C:) O O . 0 ch O c0 O M O O N 4O er . ap Ian t1 ) �� ep 3f k P _ Y W E '. N �' r O EA a � lA, pT 9?9 -Lt .. n F -9 L . S . ?ir. I : . .. . F 1 99 91 III f 4 f } w'y�f4l E .Ti! 1.., f S➢I I. E S 5� S ¢c.i-g? f q t" . 1 r agy A' : t 3 f 11 s „mill I R y v Ed t �� t i E O ' Ie lx s{&„^u5J«�`�� e r _Ali #, � %%er It E `�t t 1E h '. � X v ,fs O XA A 91 A ( { Y 'E f f4gf iLi S S t ytia fY f E k ,�u 7 , E a19 'v k . Lo v'r1 t 1E rash -� ✓, S :' € € �t O tt a` e EI '6� 6 :� R A�k�R+ EE<f r E "'+ Eie a At�f - tt lo-�E 1~ary t doff Duh%xa ' ae � 41 A • . . ell -1 1 A,I'TAA&&91 �rnale, E r EE f SE€E fz ij �. ''''ddddKn 1 (° s p yjk tt 'dE § i nL t { a ` X 't ��d , i f 411 A I ON @ EF m P 61 s r I , ., O F E s s k ` O � O00 O O O r fi O "wfl € ; O aEss f O t O lf� Y O N 3� O 'x" t m y o- (V m tt�i r f 43 N O {qk ' �t^vLe fi T0111 M E 4� j 'Ale" c E '� ' " . z `' ` ' f co * E Kf€€ A O to 0 gypp}} E s i cav € �Eex{t� E re LO H U s� d' 5 dih fh�C j Mi f ffa'E �' 1AV All, All ca Z` � �. atr � 11 €E E tt " ac_'z t u E ll"llr!n ; iR tC ( E E � ' w .a ' ` z tE �` EE rS lE � : N 5 ep, a.. t, k 'Yt s 3 ..� d : ti Q t _ s Qo,,,� rap sa a r q �, ak ' iIi£,0! r h{ y . C a > 0. k n >ifr a" �E 1 .� e 5, Y t .'•s' S6 u'^ 4 F71 A 144 f x I �` 'B�Li Y LS EE �ttn :f rt �A i Eel tit E �gwEy. + a t , KE € '`'Tfi E a TtE i€ 6j '' s E .p _ � a. ' " ia�' lg 4 r .Y y , , V iy. 34 [�}� 111 E' S' {✓5,- AF lsrr E w, k ,yj`. wLr i t {y Ru 2 E L gkiE EA �' £pE`�E€r £ Nf o & fVk a E V d{{ � Et �E rAiiii,ZEpE. r,f t rr R E �1�'a' t 4 t9 f V � ��P MYm ilRili 4R 4r'INs �E 1 4 6 A ok Will r , `.•t � . �` � �t tE r. EtE�,: f�ia vEA 11 mi t tt`� n k aV F 919 CL w rsi K•k"Aw• 3 C y � d As W w t f E7_ Z uj Z W C O C O C LL � 011111111 N A V 0 99, All C 7o m _G�1 O W p CL c W O o d CSON w a` m li Q Q U) O � IV to w cq a it a J MEN Boys A aw Canr of kAw RWw County, Ino. - Ssbns Bmd1 Grant AoM=Von to ms CMdws S� Advey Cerneee UNIFORM GRANT APPLICATION TOTAL AGENCY BUDGET AGENCY/PROGRAM NAME: Bos & Girls Clubs of Indian River County - Sebastian Branch FY 03/04 FY 04/05 FY 05/06 % INCREASE FYE June 30 FYE June 30 HE June 30 CURRENT VS. NEXT FY BUDGET A B C D ACTUAL TOTAL PROPOSED (Col. o-Col. Bpcol. a REVENUES BUDGETED BUDGETED 1 Children's Services Council-St. Lucie 0.00 0.00 0.00 #DIV/01 2 Children's Services Council-Martin 0.00 0.00 0.00 #DIV/01 3 Advisory Committee-Indian River 100 474.08 95 540.00 105 000.00 9.90% 4 United Way-St Lucie County 0.00 0.00 0.00 #DIV/01 6 United Way-Martin Countv 0.00 0.00 0.00 #DIV/01 6 United Way-Indian River County 125 999.88 131 000.00 150 000.00 14.50% 7 Department of Children & Families 0.00 0.00 0.00 #DIV/01 s County Funds 0.00 0.00 0.00 #DIV/01 9 Contributions-Cash 186 072.79 291 550.00 283 875.00 -2.63% 10 Pro ram Fees 4 065.56 31400.00 81000.00 135.29% 11 Fund Raising Events-Net 181 684.00 104 625.00 117 900.00 12.69% 12 Sales to Public-Net 0.00 0.00 0.00 #DIV/01 13 Membership Dues 71699.00 71699,00 18 000.00 133.80% 14 Investment Income 11333,91 0.00 0.00 #DIV/01 1s Miscellaneous 29096.001 0.00 0.00 #DIV/01 16 Legacies & Bequests 0.00 0.00 0.00 #DIV/01 17 Funds from Other Sources 127t995,961 84t874,00 207 684.00 144.70% 1a Reserve Funds Used for Operating 0.00 0.00 0.00 #DIV/01 19 In-Kind Donations (Not Included In total) 22 394.82 12 000.00 12 000.00 0.00% 20 TOTAL 759 816.00 718 688.00 890 459.00 23.90% g . a . . r _ - EXPENDITURES 21 Salaries 350 360.94 403 287.00 495 838.00 22.95% 22 FICA 26s769,53 30 851 .00 37 932.00 22.95% 23 Retirement 11t985,05 1967400 2625000 33.42% 24 Life/Health 119j327,52 28 290.00 4298900 51 .96% 25 Workers Compensation 81792,38 12 082.00 13 288.00 9.98% 26 Florida Unemployment 804.77 29802.00 31969.00 41 .65% 27 Travel-Daily 12416,86 5 500.00 11 130.00 102.36% 2a Travel/Conferences/Training 69056.99 20163.00 19 834.00 -1 .63% 29 Office Supplies 6199.78 31654.00 4150.00 13.57% 30 Telephone 11 ,810,75 12 060.00 1494000 23.88% 31 Postage/Shippini 1 498.51 1469,00 19937.00 65.70% 32 Utilities 14160.17 1650000 767600 -53.48% 33 Occupancy (Building & Grounds 90 311 .61 82 988.00 106 055.00 27.80% 34 Printing & Publications 15 348.62 16 500.00 20 500.00 24.24% 35 Subscription/Dues/Memberships 8,924,88 9t835,00 91835.00 0.00% 36 Insurance 18 943.78 22 642.00 29 890.00 32.01 % 37 E ui ment:Rental & Maintenance 13 007.00 89863.00 1158800 30.75% 38 Advertisin-q 415.00 600.00 600.00 0.00% 39 Equipment Purchases:Ca ital Expense 0.00 0.00 0.00 #DIV/01 4o Professional Fees Le al Consultin 59673,14 0.00 0.00 #DIV/01 41 Books/Educational Materials 9166.31 10 721 .00 11j492.001 7.19% 42 Food & Nutrition 342.73 400.00 3,840,00 860.00% 43 Administrative Costs 2,692,24 41500,00 450000 0.00% 44 Audit Expense 71360,00 70000,00 79500.00 7. 14% 45 Specific Assistance to Individuals 0.00 0.00 0.00 #DIV/01 46 Other/Miscellaneous 41 116. 13 10 067.00 16 723.00 66. 12% 47 Other/Contract 0.00 0.00 0.00 #DIV/01 48 TOTAL 672!484169 730148.00 90224 0 23.6001 % 49 REVENUES OVER/ UNDER EXPENDITURES 87t331 .31 -11 460.00 -11 ,997,00 4.69% 5/162005' 19 Number of i ys � y n Budget 2004/05 � 1 M. , , Hobe Sound 011141116 1 a lulls 1 1 1 ■ s Port Saint Co.� Total St. Lucie •1 i .1. _ , Ii 11 _ I tell V41 W44 51 FIN D) I 1253 � l� , �t e b 4 S id �k v^ i �a'"'EE F � ( ��4° 4� ,.,a ' Fiscal � �-�. � i n a t gg yy1 Budget � � � � 1 P o o 1IlIff MA ILI"016 Total Children 19 to / ® � ® 1LAdu • 1 TotalI , a i Boys & Gins Clubs of Indian River County, Inc. - Sebastian Branch Grant Application to the Children's Services Advisory Committee UNIFORM GRANT APPLICATION BUDGET NARRATIVE WORKSHEET IMPORTANT: The Budget Narrative should provide details to justify the amount requested in each line item of the budget for your program. From this worksheet, your figures will be linked to the Total Agency Budget, Total Program Budget and Funder Specific Budget Forms. AGENCY/PROGRAM NAME : Boys & Girls Clubs of Indian River County - Sebastian Branch FUNDER : Children 's Services Advisory Committee CAUTION : Do not enter any figures where a cell is colored in dark blue - Formulas and/or links are in place. Gray areas should abe used for providing information. and calculations only. � �Ir�r 5e �c rKs foal �igency g rt3 utatg Budget .. u. _ . . . ,u . < . . .. .. , Mail Win nw� 1 Children's Services Council-St Lucie 0.00 0 . 00 2 Children's Services Council-Martin 0 .00 0 . 00 3 Advisory Committee-Indian River 35 , 000 .00 35, 000.00 1059000 . 00 4 United Way-St Lucie County 0.00 0 . 00 5 United Way-Martin County 0 .00 0. 00 6 United Way-Indian River County 55 , 000. 00 150, 000 .00 7 Department of-Children & Families 0.00 0 . 00 8 County Funds 0.00 0 . 00 9 Contributions-Cash 0. 00 283 , 875 .00 10 Program Fees 41250 . 00 81000 . 00 11 Fund Raising Events-Net 21500 . 00 117 , 900 . 00 12 Sales to Public - Net 0 . 00 0 . 00 13 Membership Dues 10,500.00 18 , 000. 00 14 Investment Income 0.00 0. 00 15 Miscellaneous 0.00 0 . 00 16 Le acies & Bequests 0.00 0 . 00 17 Funds from Other Sources 82 , 747 .00 207 ,684 . 00 18. Reserve Funds Used for Operating 0 .00 0. 00 19 in-Kind Donations (Not included in total) 0 .00 129000. 00 20 TOTAL REVENUES (doesn't Include line 19) $ 189 ,997. 00 1 $35 , 000 . 00 $890 ,459 . 00 ? = tDu R7 v : Int i Of i A eNc � s � B. r~x�l Vit_ as a 21 Salaries - (must complete chart on next page) 140,077 . 00 30 ,000 . 00 495 , 838 . 00 22 :FICA`- Total salaries x 0. 0765 10 , 716 .00 11912 . 50 37 , 932 . 00 Retiremennnual pension or qua 1 le 23 staff 41200 . 00 0 .00 26 , 250. 00 09`145aa Ica en a O - erm 24 Disab. 81164 . 00 31087 . 50 42 , 989 . 00 Workers Compensation - # employees x 25 rate 31754 .00 0 . 00 13 , 288 . 00 Florida Unemployment - # projected 26 employees x $7, 000 x UCT-6 rate 11042 . 00 0 . 001 3 , 969 . 00 5/16/2003 15 Boyo a OW CkAe of Inion River Cm*. Inc. - SetuOen Bruch Q" Ap*dim b #W Chttren'e Senxae M.Lay Cmrdlee UNIFORM GRANT APPLICATION TOTAL PROGRAM BUDGET AGENCY/PROGRAM NAME: Bos & Girls Clubs of Indian River County - Sebastian Branch FY 03/04 FY 04/05 FY 05/06 % INCREASE FYE June 30 FYE June 30 FYE June 30 CURRENT VS. NEXT FY BUDGET A B C D ACTUAL TOTAL PROPOSED (col. C-Col. Byeol. e REVENUES BUDGETED BUDGETED 1 Children's Services CouncilSt Lucie 0.00 0.00 0.00 #DIV/OI 2 Children's Services Council-Martin 0.00 0.00 0.00 #DIV/01 3 Advisory Committee-Indian River 30 622.32 30 000.00 35 000.00 16.67% 4 United Way-St Lucie County 0.00 0.00 0.00 #DIV/01 5 United Way-Martin County 0.00 0.00 0.00 #DIV/01 B United Way-Indian River County 39t999,96 45 000.00 55 000.00 22.22% 7 Department of Children & Families 0.00 0.00 0.00 #DIV/01 s County Funds 0.00 0.00 0.00 #DIV/01 9 Contributions-Cash 11342,821 0.00 0.00 #DIV/01 10 Program Fees 2147.00 21020,00 49250,00 110.40% 11 Fund Ralsina Events-Net 910.00 0.00 21600,001 #DIV/01 12 Sales to Public-Net 0.00 0.00 0.00 #DIV/01 13 Membership Dues 41680.00 49669,00 1050000 124.89% 14 Investment Income 47.59 0.00 0.00 #DIV/01 15 Miscellaneous 895.00 0.00 0.00 #DIV/01 16 Le acies & Bequests 0.00 0.00 0.00 #DIV/01 17 Funds from Other Sources 43t6118.36 32 437.00 82 747.00 155.10% is Reserve Funds Used for Operating 0.00 0.00 0.00 #DIV/01 19InAindDonation slNotIncluded In totaq 6990.62 0.00 0.00 #DIV/0l 20 TOTAL 131 253.67 114126.00 189 997.00 66.48% EXPENDITURES 21 Salaries 74 641 .04 141s572.00 140 077.00 -1 .06% 22 FICA 51736.97 10 830.00 10 716.00 -1 .05% 23 Retirement 31073.28 300000 4 200.00 40.00% 24 Life/Health 49403,50 7t646.00 8164.00 6.79% 25 Workers Compensation 1 ,847,471 39794,00 347M,001 -1 .05% 26 Florida Unemployment 0.00 961 .00 19042.00 8.43% 27 Trevel-Dally 495.73 11125,00 525.00 53.33% 29 Travel/Conferences/Training 752.54 59511 .00 69868.00 24.44% 29 Office Supplies 11526,98 360.00 550.00 52.78% 30 Telephone 3t493.87 31580.00 3,820.00 6.70% 31 Postage/Shipping 105.91 0.00 104.00 #DIV/Ol 32 Utilities 8112.29 81200,00 3 798.00 -53.68% 33 occupancy (Building & Grounds 35 779.93 43 043.00 64t485.00 49.82% 34 Printing & Publications 1 781 .95 1 J50,00 19750,00 0.00% . 35 Subscri on/Dues/Membershi 1 051 .141 200.00 1666,00 38.63% 36 Insurance 31301 ,12 C032,00 8t460.00 40.25% 37 E ui ment:Rental & Maintenance 1 708.05 1 ,621 ,00 21296,001 41 .64% 3s Advertisina 0.00 0.00 0.00 #DIV/01 39 Equipment Purchases:Ca ltal Expense 0.00 0.00 0.00 #DIV/01 4o Professional Fees (Legal, Consulting) 11759,38 0.00 0.00 #DIV/Ol 41 Books/Educational Materials 31662.60 31420,00 4110.00 20. 18% 42 Food & Nutrition 59.64 200.00 1 92O,00 860.00% 43 Administrative Costs 0.00 200.00 200.00 0.00% 44 Audit Expense 11840,00 11750.00 1 W875100 7. 14% 45 SpecMc Assistance to Individuals 0.00 0.00 0.00 #DIV/01 4s Other/Miscellansous 31376,32 2303,00 4132.00 79.42% 47 Other/Contract 0.00 0.00 0.00 #DIV/0l 45 TOTAL 158 409.71 248vO97,001 274 502.00 10,64eh 49 REVENUES OVER/ UNDER EXPENDITURES -27156.04 -1339971 .001 -84505.00 -36.92% 511 W-0s' 20 Boys & Gids Clubs of Indian River County, Inc. - Sebastian Branch Grant Application to the Children's Services Advisory Committee UNIFORM GRANT APPLICATION FUNDER SPECIFIC BUDGET PROGRAM EXPENSES AGENCY/PROGRAM NAME : Boys & Girls Clubs of Indian River County - Sebastian Branch FUNDER : Children's Services Advisory Committee A B C FY 05/06 FY 05/06 % OF TOTAL FUNDER TOTAL VS . PROGRAM SPECIFIC FUNDER REQUEST BUDGET BUDGET col. B/col. A EXPENDITURES 21 Salaries 1409077.00 30 , 000. 00 21 .42% 22 FICA 0.00 11912 .50 #DIV/0 ! 23 Retirement 0.00 0. 00 #DIV/01 24 Life/Health 0.00 31087 . 50 #DIV/0 ! 25 Workers Compensation 0 .00 0 . 00 #DIV/O ! 26 Florida Unemployment 0. 00 0 . 00 #DIV/O ! 27 Travel-Dail 0.00 0 . 00 #DIV/01 28 Travel/Conferences/Train Ing 0.00 0 . 00 #DIV/0 ! 29 Office Supplies 0.00 0.00 #DIV/0 ! 30 Telephone 0200 0 . 00 #DIV/01 31 Postage/Shipping 0.00 0. 00 #DIV/01 32 Utilities 0.00 0. 00 #DIV/0 ! 33 Occupancy (Building & Grounds 0 .00 0. 00 #DIV/01 34 Printing & Publications 0 .00 0. 00 #DIV/0 ! 35 Subscription/Dues/Memberships 0 .00 0 . 00 #DIWO ! 36 Insurance 0 .00 0 . 00 #DIV/0 ! 37 Equipment: Rental & Maintenance 0 .00 0 . 00 #DIV/01 38 Advertising 0 .00 0 . 00 #DIV/0 ! 39 Equipment Purchases : Ca ital Expense 0 .00 0. 00 #DIV/01 40 Professional Fees (Legal Consulting) 0.00 0 .00 #DIV/01 41 Books/Educational Materials 0. 00 0.00 #DIV/0 ! 42 Food & Nutrition 0. 00 0 .00 #DIV/0 ! 43 Administrative Costs 0.00 0. 00 #DIV/01 44 Audit Expense 0. 00 0 .00 #DIV/01 45 Specific Assistance to Individuals 0.00 0 .00 #DIV/01 46 Other/Miscellaneous 0 .00 0 .00 #DIV/0 ! 47 Other/Contract 0. 00 108001 #DIV/01 a 48 TOTAL $ 140, 077.00 $35 , 000.00 24 . 990%. 5H 6/2005; � l o 0 0 o o o 0 o 0 o L, P' O O O O O O O O O O O 't' O V' 0 0 0 0 0 0 0 �J d 7a O 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 11 11a= r ; O N O O O O O O O p � 0 CN 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 O to 0000000 _ tp ? lcx O co x" Ell, 0 00000000000 ui LOM :F � iyhk \ r ti J . :n3ro�f re it a IN �s r . x � � � 000000000 � � 000000000 000000000 O M M } .� s s ' arz U sY`4 .A X S s s E bt E. 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C 3 ' l ,I I'l C 3`+C7E " . : G ., �. 6 6g 1 - 1 n 1, �E F" C m a � O a cm p a c � � N ;rt " i CIIIm C w O ii I I m CL m 3 G m v , F>- . . . . . ° E d m pm ' m w W � °•> m R m� m 3 >O d j °1w 11I�e h O A O mmN M a} N Co ti O N N N 0 M M M M 0 0 M M Boys a Dirk Clubs of Indian RWw County, Im - Sebastian Brmch Grant Appicabon to dM Chidren's Service Ado6ary Commdtee , UNIFORM GRANT APPLICATION EXPLANATION FOR VARIANCES OF 15% OR MORE TOTAL PROGRAM BUDGET AGENCY/PROGRAM NAME: Boys & Girls Clubs of Indian River County - Sebastian Branch FUNDER: Children's Services Advisory Committee #DIVIO1 NIOI Since we anticipate opening the doors to our new 6,500 square feet facility in late 2005 , we are requesting additional funding which will Advisory Committee-Indlan River enable us to serve more kids per day. #DIVIOI #DN101 Since we anticipate opening the doors to our new 6,500 square feet facility in late 2005, we are requesting additional funding which will United Way-Indian River County enable us to serve more kids per day. #DIV/01 #DIVIOI EfflaMm F�M Based on the anticipated number of kids registering for the program. #DIVIOI NDIVIOI Membership Dues Based on the anticipated number of kids registering for the program. #DIVIOI #DIVIOf Funs orn Other Sources We are in the process of seeking out new grant opportunities. rot rot Retirement Additional staff members eligible for the pension plan. TrayWonferencesiTraining We base our training/travel budget on 5% of the ram's salary budget, so when that increases so does this fine item. Office supplies Anticipated increase in office supply needs based on current year trends. /0 cuponcy (Buildingd Grounds We anticipate a rent increase as well as moving into our new building in late 2005. Subscription/DuesiMemberships BGCA due increase based on number of kids served and budget size. Insurance Annual increases/addition of another shuttle bus to insure. Ecuipment:Rental3 Maintenance Copier maintenance and supplies costs have increased. 1 Books/Educational rial Based on increase in supplies to serve more kids. Food & Nutrition The Club now offers healthy snacks to members for a fee in addition to what is provided by the school district. Member field trips/travel is included in this line item and all programs are always seeking out new and exciting trips to take using funds 131:01118110013111 raised by their Advisory Councils. snerzooe Boys a Gids Clubs of Indian Riva County, Inc. - Sebastian Branch Gram Application to the Chidren's Services Advisory Commitee UNIFORM GRANT APPLICATION EXPLANATION FOR VARIANCES OF 15% OR MORE FUNDER SPECIFIC BUDGET AGENCY/PROGRAM NAME: Boys & Girls Clubs of Indian River County - Sebastian Branch FUNDER: Children's Services Advisory Committee Our request is for the funding of our Branch Director's Salary/Benefits for which the portion charged off to this grant would be 24 . 99% of 7#DIV/01 the program's bud et. IV/01 #D 101 N101 #DN/01 #DIV/01 101 #DIV/01 IV/Of #DIV Of #DN/OI /0 #D /01 _ #DIVIOI #DN/01 #D 101 #DN/06 #DN/04 #QIVIOI #DIV/Of I #DIV/O1 #DN101 5/18lZOOSS 2J 000 0 0 o00o o 0 0 0 o . . o 1 A 0 0 0 O ON C:) O O . 0 ch O c0 O M O O N 4O er . ap Ian t1 ) �� ep 3f k P _ Y W E '. 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''''ddddKn 1 (° s p yjk tt 'dE § i nL t { a ` X 't ��d , i f 411 A I ON @ EF m P 61 s r I , ., O F E s s k ` O � O00 O O O r fi O "wfl € ; O aEss f O t O lf� Y O N 3� O 'x" t m y o- (V m tt�i r f 43 N O {qk ' �t^vLe fi T0111 M E 4� j 'Ale" c E '� ' " . z `' ` ' f co * E Kf€€ A O to 0 gypp}} E s i cav € �Eex{t� E re LO H U s� d' 5 dih fh�C j Mi f ffa'E �' 1AV All, All ca Z` � �. atr � 11 €E E tt " ac_'z t u E ll"llr!n ; iR tC ( E E � ' w .a ' ` z tE �` EE rS lE � : N 5 ep, a.. t, k 'Yt s 3 ..� d : ti Q t _ s Qo,,,� rap sa a r q �, ak ' iIi£,0! r h{ y . C a > 0. k n >ifr a" �E 1 .� e 5, Y t .'•s' S6 u'^ 4 F71 A 144 f x I �` 'B�Li Y LS EE �ttn :f rt �A i Eel tit E �gwEy. + a t , KE € '`'Tfi E a TtE i€ 6j '' s E .p _ � a. ' " ia�' lg 4 r .Y y , , V iy. 34 [�}� 111 E' S' {✓5,- AF lsrr E w, k ,yj`. wLr i t {y Ru 2 E L gkiE EA �' £pE`�E€r £ Nf o & fVk a E V d{{ � Et �E rAiiii,ZEpE. r,f t rr R E �1�'a' t 4 t9 f V � ��P MYm ilRili 4R 4r'INs �E 1 4 6 A ok Will r , `.•t � . �` � �t tE r. EtE�,: f�ia vEA 11 mi t tt`� n k aV F 919 CL w rsi K•k"Aw• 3 C y � d As W w t f E7_ Z uj Z W C O C O C LL � 011111111 N A V 0 99, All C 7o m _G�1 O W p CL c W O o d CSON w a` m li Q Q U) O � IV to w cq a it a J MEN Boys A aw Canr of kAw RWw County, Ino. - Ssbns Bmd1 Grant AoM=Von to ms CMdws S� Advey Cerneee UNIFORM GRANT APPLICATION TOTAL AGENCY BUDGET AGENCY/PROGRAM NAME: Bos & Girls Clubs of Indian River County - Sebastian Branch FY 03/04 FY 04/05 FY 05/06 % INCREASE FYE June 30 FYE June 30 HE June 30 CURRENT VS. NEXT FY BUDGET A B C D ACTUAL TOTAL PROPOSED (Col. o-Col. Bpcol. a REVENUES BUDGETED BUDGETED 1 Children's Services Council-St. Lucie 0.00 0.00 0.00 #DIV/01 2 Children's Services Council-Martin 0.00 0.00 0.00 #DIV/01 3 Advisory Committee-Indian River 100 474.08 95 540.00 105 000.00 9.90% 4 United Way-St Lucie County 0.00 0.00 0.00 #DIV/01 6 United Way-Martin Countv 0.00 0.00 0.00 #DIV/01 6 United Way-Indian River County 125 999.88 131 000.00 150 000.00 14.50% 7 Department of Children & Families 0.00 0.00 0.00 #DIV/01 s County Funds 0.00 0.00 0.00 #DIV/01 9 Contributions-Cash 186 072.79 291 550.00 283 875.00 -2.63% 10 Pro ram Fees 4 065.56 31400.00 81000.00 135.29% 11 Fund Raising Events-Net 181 684.00 104 625.00 117 900.00 12.69% 12 Sales to Public-Net 0.00 0.00 0.00 #DIV/01 13 Membership Dues 71699.00 71699,00 18 000.00 133.80% 14 Investment Income 11333,91 0.00 0.00 #DIV/01 1s Miscellaneous 29096.001 0.00 0.00 #DIV/01 16 Legacies & Bequests 0.00 0.00 0.00 #DIV/01 17 Funds from Other Sources 127t995,961 84t874,00 207 684.00 144.70% 1a Reserve Funds Used for Operating 0.00 0.00 0.00 #DIV/01 19 In-Kind Donations (Not Included In total) 22 394.82 12 000.00 12 000.00 0.00% 20 TOTAL 759 816.00 718 688.00 890 459.00 23.90% g . a . . r _ - EXPENDITURES 21 Salaries 350 360.94 403 287.00 495 838.00 22.95% 22 FICA 26s769,53 30 851 .00 37 932.00 22.95% 23 Retirement 11t985,05 1967400 2625000 33.42% 24 Life/Health 119j327,52 28 290.00 4298900 51 .96% 25 Workers Compensation 81792,38 12 082.00 13 288.00 9.98% 26 Florida Unemployment 804.77 29802.00 31969.00 41 .65% 27 Travel-Daily 12416,86 5 500.00 11 130.00 102.36% 2a Travel/Conferences/Training 69056.99 20163.00 19 834.00 -1 .63% 29 Office Supplies 6199.78 31654.00 4150.00 13.57% 30 Telephone 11 ,810,75 12 060.00 1494000 23.88% 31 Postage/Shippini 1 498.51 1469,00 19937.00 65.70% 32 Utilities 14160.17 1650000 767600 -53.48% 33 Occupancy (Building & Grounds 90 311 .61 82 988.00 106 055.00 27.80% 34 Printing & Publications 15 348.62 16 500.00 20 500.00 24.24% 35 Subscription/Dues/Memberships 8,924,88 9t835,00 91835.00 0.00% 36 Insurance 18 943.78 22 642.00 29 890.00 32.01 % 37 E ui ment:Rental & Maintenance 13 007.00 89863.00 1158800 30.75% 38 Advertisin-q 415.00 600.00 600.00 0.00% 39 Equipment Purchases:Ca ital Expense 0.00 0.00 0.00 #DIV/01 4o Professional Fees Le al Consultin 59673,14 0.00 0.00 #DIV/01 41 Books/Educational Materials 9166.31 10 721 .00 11j492.001 7.19% 42 Food & Nutrition 342.73 400.00 3,840,00 860.00% 43 Administrative Costs 2,692,24 41500,00 450000 0.00% 44 Audit Expense 71360,00 70000,00 79500.00 7. 14% 45 Specific Assistance to Individuals 0.00 0.00 0.00 #DIV/01 46 Other/Miscellaneous 41 116. 13 10 067.00 16 723.00 66. 12% 47 Other/Contract 0.00 0.00 0.00 #DIV/01 48 TOTAL 672!484169 730148.00 90224 0 23.6001 % 49 REVENUES OVER/ UNDER EXPENDITURES 87t331 .31 -11 460.00 -11 ,997,00 4.69% 5/162005' 19 EXHIBIT B ( From policy adopted by Indian River County Board of county Commissioners on February 19 , 2002 ) " D. Nonprofit Agency Responsibilities After Award Funding Indian River County provides funding to all nonprofit agencies on a reimbursement basis only. All reimbursable expenses must be documented by an invoice and/or a copy of the canceled check . Any expense not documented properly to the satisfaction of the Office of Management & Budget and/or the County Administrator may not be reimbursed . If an agency repeatedly fails to provide adequate documentation , this may be reported to the Board of Commissioners . In the event an agency provides inadequate documentation on a consistent basis , funding may be discontinued immediately. Additionally, this may adversely affect future funding requests . Expenditures may only be reimbursed from the fiscal year for which funding was awarded . For example , no expenditures prior to October 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 and (September 30th) must be submitted on a timely basis . Each year, the Office of Management and Budget will send a letter to all nonprofit agencies advising of the deadline for reimbursement requests for the fiscal year. This deadline is typically early to mid October, since the Finance Department does not process checks for the prior fiscal year beyond that point. Each reimbursement request must include a summary of expense by type . These summaries should be broken down into salaries , benefit, supplies , contractual services , etc . If Indian River County is reimbursing an agency for only a portion of an expense (e . g . salary of an employee ) , then the method for this portion should be disclosed on the summary. The Office of Management & Budget has summary forms available . Indian River County will not reimburse certain types of expenditures . These expenditure types are listed below. a ) Travel expenses for travel outside the County including but not limited to : mileage reimbursement, hotel rooms , meals , meal allowances , per diem , and tolls . Mileage reimbursement for local travel (within Indian River County) is allowable . b ) Sick or Vacation payments for employees . Since agencies may have various sick and vacation pay policies , these must be provided from other sources . c) Any expenses not associated with the provision of the program for which the County has awarded funding . d ) Any expense not outlined in the agency's funding application . The County reserves the right to decline reimbursement for any expense as deemed necessary. " EXHIBIT - B - 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 1840 25th Street Vero Beach , Florida 32960-3365 Recipient: Boys & Girls Clubs of Indian River County P . O . Box 643068 Vero Beach , Florida 32964 Attention : Ronnie Hewett, President , CEO 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 . Severabilitv. In the event any provision of this Contract is determined to be unenforceable or invalid , such unenforceability or invalidity shall not affect the remaining provisions of this Contract, and every other provision and term of this Contract shall be deemed valid and enforceable to the extent permitted by law . To that extent, this Contract is deemed severable . 5 . Captions and Interpretations Captions in this Contract are included for convenience only and are not to be considered in any construction or interpretation of this Contract or any of its provisions . Unless context indicates otherwise , words importing the singular number include the plural number, and vise versa . Words of any gender include the correlative words of the other genders , unless the sense indicates otherwise . 6 . Independent Contractor. The Recipient is and shall be an independent contractor for all purposes under this Contract. The Recipient is not an agent or employee of the County, and any and all persons engaged in any of the services or activities funded in whole or in part performed pursuant to this Contract shall at all times and in all places be subject to the Recipient's sole direction , supervision and control . 7 . Assignment . This Contract may not be assigned by the Recipient without the prior written consent of the County. EXHIBIT - C - Boyo a OW CkAe of Inion River Cm*. Inc. - SetuOen Bruch Q" Ap*dim b #W Chttren'e Senxae M.Lay Cmrdlee UNIFORM GRANT APPLICATION TOTAL PROGRAM BUDGET AGENCY/PROGRAM NAME: Bos & Girls Clubs of Indian River County - Sebastian Branch FY 03/04 FY 04/05 FY 05/06 % INCREASE FYE June 30 FYE June 30 FYE June 30 CURRENT VS. NEXT FY BUDGET A B C D ACTUAL TOTAL PROPOSED (col. C-Col. Byeol. e REVENUES BUDGETED BUDGETED 1 Children's Services CouncilSt Lucie 0.00 0.00 0.00 #DIV/OI 2 Children's Services Council-Martin 0.00 0.00 0.00 #DIV/01 3 Advisory Committee-Indian River 30 622.32 30 000.00 35 000.00 16.67% 4 United Way-St Lucie County 0.00 0.00 0.00 #DIV/01 5 United Way-Martin County 0.00 0.00 0.00 #DIV/01 B United Way-Indian River County 39t999,96 45 000.00 55 000.00 22.22% 7 Department of Children & Families 0.00 0.00 0.00 #DIV/01 s County Funds 0.00 0.00 0.00 #DIV/01 9 Contributions-Cash 11342,821 0.00 0.00 #DIV/01 10 Program Fees 2147.00 21020,00 49250,00 110.40% 11 Fund Ralsina Events-Net 910.00 0.00 21600,001 #DIV/01 12 Sales to Public-Net 0.00 0.00 0.00 #DIV/01 13 Membership Dues 41680.00 49669,00 1050000 124.89% 14 Investment Income 47.59 0.00 0.00 #DIV/01 15 Miscellaneous 895.00 0.00 0.00 #DIV/01 16 Le acies & Bequests 0.00 0.00 0.00 #DIV/01 17 Funds from Other Sources 43t6118.36 32 437.00 82 747.00 155.10% is Reserve Funds Used for Operating 0.00 0.00 0.00 #DIV/01 19InAindDonation slNotIncluded In totaq 6990.62 0.00 0.00 #DIV/0l 20 TOTAL 131 253.67 114126.00 189 997.00 66.48% EXPENDITURES 21 Salaries 74 641 .04 141s572.00 140 077.00 -1 .06% 22 FICA 51736.97 10 830.00 10 716.00 -1 .05% 23 Retirement 31073.28 300000 4 200.00 40.00% 24 Life/Health 49403,50 7t646.00 8164.00 6.79% 25 Workers Compensation 1 ,847,471 39794,00 347M,001 -1 .05% 26 Florida Unemployment 0.00 961 .00 19042.00 8.43% 27 Trevel-Dally 495.73 11125,00 525.00 53.33% 29 Travel/Conferences/Training 752.54 59511 .00 69868.00 24.44% 29 Office Supplies 11526,98 360.00 550.00 52.78% 30 Telephone 3t493.87 31580.00 3,820.00 6.70% 31 Postage/Shipping 105.91 0.00 104.00 #DIV/Ol 32 Utilities 8112.29 81200,00 3 798.00 -53.68% 33 occupancy (Building & Grounds 35 779.93 43 043.00 64t485.00 49.82% 34 Printing & Publications 1 781 .95 1 J50,00 19750,00 0.00% . 35 Subscri on/Dues/Membershi 1 051 .141 200.00 1666,00 38.63% 36 Insurance 31301 ,12 C032,00 8t460.00 40.25% 37 E ui ment:Rental & Maintenance 1 708.05 1 ,621 ,00 21296,001 41 .64% 3s Advertisina 0.00 0.00 0.00 #DIV/01 39 Equipment Purchases:Ca ltal Expense 0.00 0.00 0.00 #DIV/01 4o Professional Fees (Legal, Consulting) 11759,38 0.00 0.00 #DIV/Ol 41 Books/Educational Materials 31662.60 31420,00 4110.00 20. 18% 42 Food & Nutrition 59.64 200.00 1 92O,00 860.00% 43 Administrative Costs 0.00 200.00 200.00 0.00% 44 Audit Expense 11840,00 11750.00 1 W875100 7. 14% 45 SpecMc Assistance to Individuals 0.00 0.00 0.00 #DIV/01 4s Other/Miscellansous 31376,32 2303,00 4132.00 79.42% 47 Other/Contract 0.00 0.00 0.00 #DIV/0l 45 TOTAL 158 409.71 248vO97,001 274 502.00 10,64eh 49 REVENUES OVER/ UNDER EXPENDITURES -27156.04 -1339971 .001 -84505.00 -36.92% 511 W-0s' 20 Boys & Gids Clubs of Indian River County, Inc. - Sebastian Branch Grant Application to the Children's Services Advisory Committee UNIFORM GRANT APPLICATION FUNDER SPECIFIC BUDGET PROGRAM EXPENSES AGENCY/PROGRAM NAME : Boys & Girls Clubs of Indian River County - Sebastian Branch FUNDER : Children's Services Advisory Committee A B C FY 05/06 FY 05/06 % OF TOTAL FUNDER TOTAL VS . PROGRAM SPECIFIC FUNDER REQUEST BUDGET BUDGET col. B/col. A EXPENDITURES 21 Salaries 1409077.00 30 , 000. 00 21 .42% 22 FICA 0.00 11912 .50 #DIV/0 ! 23 Retirement 0.00 0. 00 #DIV/01 24 Life/Health 0.00 31087 . 50 #DIV/0 ! 25 Workers Compensation 0 .00 0 . 00 #DIV/O ! 26 Florida Unemployment 0. 00 0 . 00 #DIV/O ! 27 Travel-Dail 0.00 0 . 00 #DIV/01 28 Travel/Conferences/Train Ing 0.00 0 . 00 #DIV/0 ! 29 Office Supplies 0.00 0.00 #DIV/0 ! 30 Telephone 0200 0 . 00 #DIV/01 31 Postage/Shipping 0.00 0. 00 #DIV/01 32 Utilities 0.00 0. 00 #DIV/0 ! 33 Occupancy (Building & Grounds 0 .00 0. 00 #DIV/01 34 Printing & Publications 0 .00 0. 00 #DIV/0 ! 35 Subscription/Dues/Memberships 0 .00 0 . 00 #DIWO ! 36 Insurance 0 .00 0 . 00 #DIV/0 ! 37 Equipment: Rental & Maintenance 0 .00 0 . 00 #DIV/01 38 Advertising 0 .00 0 . 00 #DIV/0 ! 39 Equipment Purchases : Ca ital Expense 0 .00 0. 00 #DIV/01 40 Professional Fees (Legal Consulting) 0.00 0 .00 #DIV/01 41 Books/Educational Materials 0. 00 0.00 #DIV/0 ! 42 Food & Nutrition 0. 00 0 .00 #DIV/0 ! 43 Administrative Costs 0.00 0. 00 #DIV/01 44 Audit Expense 0. 00 0 .00 #DIV/01 45 Specific Assistance to Individuals 0.00 0 .00 #DIV/01 46 Other/Miscellaneous 0 .00 0 .00 #DIV/0 ! 47 Other/Contract 0. 00 108001 #DIV/01 a 48 TOTAL $ 140, 077.00 $35 , 000.00 24 . 990%. 5H 6/2005; � l ACORgR, CERTIFICATE OF INSURANCE ISSUE DATE (MM/DD/YY) 09- 26- 2005 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS Markel Insurance Company NO RIGHTS UPON THE CERTIFICATE HOLDER , THIS CERTIFICATE DOES NOT AMEND , P. O . BOX 3870 EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Glen Allen , VA 23058-3870 COMPANIES AFFORDING COVERAGE COMPANY CODE SUB-CODE LETTER A MARKEL INSURANCE COMPANY COMPANY INSURED B LETTER Boys & Girls Club of Indian River County, Inc . COMPANY C PO Box 3068 LETTER Vero Beach , FL 32964 COMPANY D LETTER COMPANY COVERAGES LETTER E THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED , NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN , THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES . LIMITS SHOWN MAY HAVE BEEN REDUCED BY O TR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION DATE (MM/DD/YY) DATE (MM/DD/YY) LIMITS GENERAL LIABILITY $ 3,000, 000 A X COMMERCIAL GENERAL LIABILITY GENERAL AGGREGATE PRODUCTS-COMP/OPS AGGREGATE $ 110000000 CLAIMS MADE a OCCUR . PERSONAL & ADVERTISING INJURY $ 1 ,0001000 8502CY220128- 5 09- 13-2005 09- 13-2006 OWNERS & CONTRACTOR'S PROT. EACH OCCURRENCE $ 11000, 000 FIRE DAMAGE (Any one fire) S 100,000 MEDICAL EXPENSE (Any one person) $ 5 , 000 A AUTOMOBILE LIABILITY COMBINED SINGLE X ANY AUTO LIMIT $ 110000000 X ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per Person) $ X HIRED AUTOS 8502CY220128- 5 09- 13 -2005 09- 13 -2006 BODILY INJURY X NON-OWNED AUTOS (Per accident) S GARAGE LIABILITY PROPERTY DAMAGE S EXCESS LIABILITY EACH OCCURRENCE $ UMBRELLA FORM AGGREGATE $ OTHER THAN UMBRELLA FORM WORKER 'S COMPENSATION STATUTORY LIMITS AND EACH ACCIDENT S EMPLOYERS' LIABILITY DISEASE - POLICY LI 3-4151 izt�� DISEASE - EACH, IAS YE E S A OTHER Inland Marine lJ Property 8502CY220128 5 09- 13- 2005 09- 13-2006 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS Certificate holder is included as additional insured for operations conducted by the named insured . 0z6 � e� L` CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO Indian River County MAIL._ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION Board of County Commissioners OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR 1840 25th Street REPRESENTATIVES . Vero Beach , FL 32960 00 AUTHORIZED REPRESENTATIVE Bruce A . Kay JPO ACORD 25-S( 7/90) (c ) KCORD CORPORATION 1990 OCT- 17- 2005 MON 021144 PM WM , DAY , INC , FAX NO , 772 546 5772 P . 04 Florida Retail Federation Bonrci of Trusrees Self Insurers Ge , gill" ICundrat, iceChpirurnrt George Sandcfcr, Vice C'Iruir'urlrrr FJohn i ). I tansehn;ut Nis Nissen nrpnhrivirrrJ ht, Sn„rnd! Nhrre 1979 p,('). Box 988 • L.akc hni.1, 1• 1. 33801,098Rutirtcsrrrnrnrth �lc/Lrgs. ccurr Thomas S . ('ht�rlcs k ., WiWz WinU. Ycleph011e ( 863 ) 66:)• 6060 nr 1 -800-282-7648 • Pix (863) 666- 1958 certificate of insurance RE : 0520 - 25864 ISSUED TO : Indian River County Board of county Commissioners 1840 25th St Vero Beach , FL 32960 - 3365 This is to certify that Bgys & _Qirl5 G.Ili6 of IndL2RIvcLCounty, I_[1cLp B.0 c1L3 yero Beach , 1. 32964 being subject to the provisions of the Florida Workers' Compensation Law , has secured the payment of any workers ' compensation benefits due by insuring their risk with the Florida Retail Federation Self Insurers Fund . POLICY NUMBER : 052.0:2 6154 Statutory L_lmits - - State of Florida Employers liability EFFECTIVE DATE ; $ 500 , 000 ( Each Accident) $ 500 , 000 (Disease - - Each Employee ) EXPIRA'T'ION DATE ; Selggrler 1.3 , ? 006 $ 500 , 000 ( Disease - - Policy Limit) This certificate is not a policy and of Itself does not afford any insurance . NoL'hing contained in this certificate shall be construed as amending , extending , or altering coverage not afforded by the policy shown above or affording Insurance to any Insured not named above . The policy of insurance listed above has been issued to the named insured for the policy period indicated . Notwithstanding any requirement , term or condition of any contract or other document to which this certificate may pertain , the Insurance made available by the described policy in this certificate is subject to only the terms , exclusions and conditions of such policy . Paid claims may have reduced the shown limits , If the policy described above is cancelled before the expiration date indicated , the issuing company will attempt to mail 30 days ' written notice to the certificate holder named above, although if cancellation is for nonpayrnent of premium , then the issuing company will attempt to mail 10 days ' written notice to the certificate holder . In any event, the issuing company, its agent's , and representatives accept no obligation or liability of any kind for failure to mail such notice , Date 10/ 17/ 2005 Summit, ndminisinator - ~ Florida Retail I� edoratioll Self Insurers fund Boys a Dirk Clubs of Indian RWw County, Im - Sebastian Brmch Grant Appicabon to dM Chidren's Service Ado6ary Commdtee , UNIFORM GRANT APPLICATION EXPLANATION FOR VARIANCES OF 15% OR MORE TOTAL PROGRAM BUDGET AGENCY/PROGRAM NAME: Boys & Girls Clubs of Indian River County - Sebastian Branch FUNDER: Children's Services Advisory Committee #DIVIO1 NIOI Since we anticipate opening the doors to our new 6,500 square feet facility in late 2005 , we are requesting additional funding which will Advisory Committee-Indlan River enable us to serve more kids per day. #DIVIOI #DN101 Since we anticipate opening the doors to our new 6,500 square feet facility in late 2005, we are requesting additional funding which will United Way-Indian River County enable us to serve more kids per day. #DIV/01 #DIVIOI EfflaMm F�M Based on the anticipated number of kids registering for the program. #DIVIOI NDIVIOI Membership Dues Based on the anticipated number of kids registering for the program. #DIVIOI #DIVIOf Funs orn Other Sources We are in the process of seeking out new grant opportunities. rot rot Retirement Additional staff members eligible for the pension plan. TrayWonferencesiTraining We base our training/travel budget on 5% of the ram's salary budget, so when that increases so does this fine item. Office supplies Anticipated increase in office supply needs based on current year trends. /0 cuponcy (Buildingd Grounds We anticipate a rent increase as well as moving into our new building in late 2005. Subscription/DuesiMemberships BGCA due increase based on number of kids served and budget size. Insurance Annual increases/addition of another shuttle bus to insure. Ecuipment:Rental3 Maintenance Copier maintenance and supplies costs have increased. 1 Books/Educational rial Based on increase in supplies to serve more kids. Food & Nutrition The Club now offers healthy snacks to members for a fee in addition to what is provided by the school district. Member field trips/travel is included in this line item and all programs are always seeking out new and exciting trips to take using funds 131:01118110013111 raised by their Advisory Councils. snerzooe Boys a Gids Clubs of Indian Riva County, Inc. - Sebastian Branch Gram Application to the Chidren's Services Advisory Commitee UNIFORM GRANT APPLICATION EXPLANATION FOR VARIANCES OF 15% OR MORE FUNDER SPECIFIC BUDGET AGENCY/PROGRAM NAME: Boys & Girls Clubs of Indian River County - Sebastian Branch FUNDER: Children's Services Advisory Committee Our request is for the funding of our Branch Director's Salary/Benefits for which the portion charged off to this grant would be 24 . 99% of 7#DIV/01 the program's bud et. IV/01 #D 101 N101 #DN/01 #DIV/01 101 #DIV/01 IV/Of #DIV Of #DN/OI /0 #D /01 _ #DIVIOI #DN/01 #D 101 #DN/06 #DN/04 #QIVIOI #DIV/Of I #DIV/O1 #DN101 5/18lZOOSS 2J EXHIBIT B ( From policy adopted by Indian River County Board of county Commissioners on February 19 , 2002 ) " D. Nonprofit Agency Responsibilities After Award Funding Indian River County provides funding to all nonprofit agencies on a reimbursement basis only. All reimbursable expenses must be documented by an invoice and/or a copy of the canceled check . Any expense not documented properly to the satisfaction of the Office of Management & Budget and/or the County Administrator may not be reimbursed . If an agency repeatedly fails to provide adequate documentation , this may be reported to the Board of Commissioners . In the event an agency provides inadequate documentation on a consistent basis , funding may be discontinued immediately. Additionally, this may adversely affect future funding requests . Expenditures may only be reimbursed from the fiscal year for which funding was awarded . For example , no expenditures prior to October 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 and (September 30th) must be submitted on a timely basis . Each year, the Office of Management and Budget will send a letter to all nonprofit agencies advising of the deadline for reimbursement requests for the fiscal year. This deadline is typically early to mid October, since the Finance Department does not process checks for the prior fiscal year beyond that point. Each reimbursement request must include a summary of expense by type . These summaries should be broken down into salaries , benefit, supplies , contractual services , etc . If Indian River County is reimbursing an agency for only a portion of an expense (e . g . salary of an employee ) , then the method for this portion should be disclosed on the summary. The Office of Management & Budget has summary forms available . Indian River County will not reimburse certain types of expenditures . These expenditure types are listed below. a ) Travel expenses for travel outside the County including but not limited to : mileage reimbursement, hotel rooms , meals , meal allowances , per diem , and tolls . Mileage reimbursement for local travel (within Indian River County) is allowable . b ) Sick or Vacation payments for employees . Since agencies may have various sick and vacation pay policies , these must be provided from other sources . c) Any expenses not associated with the provision of the program for which the County has awarded funding . d ) Any expense not outlined in the agency's funding application . The County reserves the right to decline reimbursement for any expense as deemed necessary. " EXHIBIT - B - 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 1840 25th Street Vero Beach , Florida 32960-3365 Recipient: Boys & Girls Clubs of Indian River County P . O . Box 643068 Vero Beach , Florida 32964 Attention : Ronnie Hewett, President , CEO 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 . Severabilitv. In the event any provision of this Contract is determined to be unenforceable or invalid , such unenforceability or invalidity shall not affect the remaining provisions of this Contract, and every other provision and term of this Contract shall be deemed valid and enforceable to the extent permitted by law . To that extent, this Contract is deemed severable . 5 . Captions and Interpretations Captions in this Contract are included for convenience only and are not to be considered in any construction or interpretation of this Contract or any of its provisions . Unless context indicates otherwise , words importing the singular number include the plural number, and vise versa . Words of any gender include the correlative words of the other genders , unless the sense indicates otherwise . 6 . Independent Contractor. The Recipient is and shall be an independent contractor for all purposes under this Contract. The Recipient is not an agent or employee of the County, and any and all persons engaged in any of the services or activities funded in whole or in part performed pursuant to this Contract shall at all times and in all places be subject to the Recipient's sole direction , supervision and control . 7 . Assignment . This Contract may not be assigned by the Recipient without the prior written consent of the County. EXHIBIT - C - ACORgR, CERTIFICATE OF INSURANCE ISSUE DATE (MM/DD/YY) 09- 26- 2005 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS Markel Insurance Company NO RIGHTS UPON THE CERTIFICATE HOLDER , THIS CERTIFICATE DOES NOT AMEND , P. O . BOX 3870 EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Glen Allen , VA 23058-3870 COMPANIES AFFORDING COVERAGE COMPANY CODE SUB-CODE LETTER A MARKEL INSURANCE COMPANY COMPANY INSURED B LETTER Boys & Girls Club of Indian River County, Inc . COMPANY C PO Box 3068 LETTER Vero Beach , FL 32964 COMPANY D LETTER COMPANY COVERAGES LETTER E THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED , NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN , THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES . LIMITS SHOWN MAY HAVE BEEN REDUCED BY O TR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION DATE (MM/DD/YY) DATE (MM/DD/YY) LIMITS GENERAL LIABILITY $ 3,000, 000 A X COMMERCIAL GENERAL LIABILITY GENERAL AGGREGATE PRODUCTS-COMP/OPS AGGREGATE $ 110000000 CLAIMS MADE a OCCUR . PERSONAL & ADVERTISING INJURY $ 1 ,0001000 8502CY220128- 5 09- 13-2005 09- 13-2006 OWNERS & CONTRACTOR'S PROT. EACH OCCURRENCE $ 11000, 000 FIRE DAMAGE (Any one fire) S 100,000 MEDICAL EXPENSE (Any one person) $ 5 , 000 A AUTOMOBILE LIABILITY COMBINED SINGLE X ANY AUTO LIMIT $ 110000000 X ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per Person) $ X HIRED AUTOS 8502CY220128- 5 09- 13 -2005 09- 13 -2006 BODILY INJURY X NON-OWNED AUTOS (Per accident) S GARAGE LIABILITY PROPERTY DAMAGE S EXCESS LIABILITY EACH OCCURRENCE $ UMBRELLA FORM AGGREGATE $ OTHER THAN UMBRELLA FORM WORKER 'S COMPENSATION STATUTORY LIMITS AND EACH ACCIDENT S EMPLOYERS' LIABILITY DISEASE - POLICY LI 3-4151 izt�� DISEASE - EACH, IAS YE E S A OTHER Inland Marine lJ Property 8502CY220128 5 09- 13- 2005 09- 13-2006 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS Certificate holder is included as additional insured for operations conducted by the named insured . 0z6 � e� L` CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO Indian River County MAIL._ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION Board of County Commissioners OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR 1840 25th Street REPRESENTATIVES . Vero Beach , FL 32960 00 AUTHORIZED REPRESENTATIVE Bruce A . Kay JPO ACORD 25-S( 7/90) (c ) KCORD CORPORATION 1990 OCT- 17- 2005 MON 021144 PM WM , DAY , INC , FAX NO , 772 546 5772 P . 04 Florida Retail Federation Bonrci of Trusrees Self Insurers Ge , gill" ICundrat, iceChpirurnrt George Sandcfcr, Vice C'Iruir'urlrrr FJohn i ). I tansehn;ut Nis Nissen nrpnhrivirrrJ ht, Sn„rnd! Nhrre 1979 p,('). Box 988 • L.akc hni.1, 1• 1. 33801,098Rutirtcsrrrnrnrth �lc/Lrgs. ccurr Thomas S . ('ht�rlcs k ., WiWz WinU. Ycleph011e ( 863 ) 66:)• 6060 nr 1 -800-282-7648 • Pix (863) 666- 1958 certificate of insurance RE : 0520 - 25864 ISSUED TO : Indian River County Board of county Commissioners 1840 25th St Vero Beach , FL 32960 - 3365 This is to certify that Bgys & _Qirl5 G.Ili6 of IndL2RIvcLCounty, I_[1cLp B.0 c1L3 yero Beach , 1. 32964 being subject to the provisions of the Florida Workers' Compensation Law , has secured the payment of any workers ' compensation benefits due by insuring their risk with the Florida Retail Federation Self Insurers Fund . POLICY NUMBER : 052.0:2 6154 Statutory L_lmits - - State of Florida Employers liability EFFECTIVE DATE ; $ 500 , 000 ( Each Accident) $ 500 , 000 (Disease - - Each Employee ) EXPIRA'T'ION DATE ; Selggrler 1.3 , ? 006 $ 500 , 000 ( Disease - - Policy Limit) This certificate is not a policy and of Itself does not afford any insurance . NoL'hing contained in this certificate shall be construed as amending , extending , or altering coverage not afforded by the policy shown above or affording Insurance to any Insured not named above . The policy of insurance listed above has been issued to the named insured for the policy period indicated . Notwithstanding any requirement , term or condition of any contract or other document to which this certificate may pertain , the Insurance made available by the described policy in this certificate is subject to only the terms , exclusions and conditions of such policy . Paid claims may have reduced the shown limits , If the policy described above is cancelled before the expiration date indicated , the issuing company will attempt to mail 30 days ' written notice to the certificate holder named above, although if cancellation is for nonpayrnent of premium , then the issuing company will attempt to mail 10 days ' written notice to the certificate holder . In any event, the issuing company, its agent's , and representatives accept no obligation or liability of any kind for failure to mail such notice , Date 10/ 17/ 2005 Summit, ndminisinator - ~ Florida Retail I� edoratioll Self Insurers fund