Loading...
HomeMy WebLinkAbout2005-328k � � - � - Us INDIAN RIVER COUNTY GRANT CONTRACT This Grant Contract ("Contract") entered into effective thisday of October 2005 , by and between Indian River County, a political subdivision of the at of Florida ; 1840 25th Street, Vero Beach , Florida , 32960-3365 ; and Child Care Resources , Inc . , ( Recipient) , of: Child Care Resources , Inc . , 1801 24th Street Vero Beach , Florida 32960 Mental Wellness Issues Program 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 - � � - � - Us INDIAN RIVER COUNTY GRANT CONTRACT This Grant Contract ("Contract") entered into effective thisday of October 2005 , by and between Indian River County, a political subdivision of the at of Florida ; 1840 25th Street, Vero Beach , Florida , 32960-3365 ; and Child Care Resources , Inc . , ( Recipient) , of: Child Care Resources , Inc . , 1801 24th Street Vero Beach , Florida 32960 Mental Wellness Issues Program 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 : SIX THOUSAND , THREE HUNDRED NINETEEN DOLLARS ($6 , 319 . 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 : ( i ) Commercial General Liability Insurance in an amount not less than $ 1 , 000 , 000 combined single limit for bodily injury and property - 2 - 4 . Grant Funds and Payment . The approved Grant for the Grant Period is : SIX THOUSAND , THREE HUNDRED NINETEEN DOLLARS ($6 , 319 . 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 : ( i ) Commercial General Liability Insurance in an amount not less than $ 1 , 000 , 000 combined single limit for bodily injury and property - 2 - 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: S Thomas S . Lowther, Chairman BCC Approved : Attest J . K . Barton , Clerk Deputy Clerk Approved : JosepA A. Baird County Administrator Ap ov as to form and leg I sufficiency: Marian E . Fell , ant County Attorney RECIPIE By: Child Care Resources , Inc . - 4 - 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 - Community Child Care Resources, Inc. Psychological Services Children 's Services Advisory Committee PROGRAM COVER PAGE Organization Name : Community Child Care Resources, Inc . Executive Director: Pamela C . King E-mail :pkingcccr@bellsouth.net Address : 1801 24`h Street Telephone : 567-3202 Vero Beach, Florida 32960 Fax : 567- 1136 Program Director: Same as above E-mail : Program Title : Psychological Services L1 Lj. Priority Need Area Addressed: MENTAL WELLNESS ISSUES : 1 . Increasing programs that promote emotional-social skills . 2 . Increasing early intervention services for "borderline" children — physical-emotional . Brief Description of the Program : This program provides parent counseling (RP450 . 650) and in- person crisis intervention (RP- 150 . 330) services to CCCR families and contracting centers . Families receive individual and/or family therapy from various contracting CCCR mental health professionals . Centers receive classroom support through site visits by therapists specializing in early childhood. children. SUMMARY REPORT — ffnter Information In The Black Cells Only) Current Program Funding ( 2004 / 05 ) : $ Dollar increase / ( decrease ) in request : $ _ . . _.. ._.. . . ... _..._. ......._....... Percent increase /( decrease ) in re uest * * 0 . 0 % Unduplicated Number of Children to be served Individually : 25 Unduplicated Number of I Adults to be served Individually : _ Unduplicated Number to be served via Group settings : 1 72 Total Program Cost per Client : 407 . 46 * * If request increased 5 % or more, briefly explain why : Centers have not received an increase in daily rates in nine years . To retain high quality care, childcare centers need to receive commensurate compensation. If these funds are being used to match another source, name the source and the $ amount : United Way, Success by Six : $4, 000 . 00 , / Organization 's Board of Directors has approved this application on e . Gla -6 2005 Thomas C . Yonge Name of President/Chair of the Board Si natu v Pamela C . King P, l\ , Name of Executive Director/CEO Signature Application for 2005 -2006 service period 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: S Thomas S . Lowther, Chairman BCC Approved : Attest J . K . Barton , Clerk Deputy Clerk Approved : JosepA A. Baird County Administrator Ap ov as to form and leg I sufficiency: Marian E . Fell , ant County Attorney RECIPIE By: Child Care Resources , Inc . - 4 - Community Child Care Resources, Inc. Psychological Services Children 's Services Advisory Committee PROPOSAL NARRATIVE Please respond to each question in the allotted space for each section. In responding to each section of the proposal narrative, please retain the section-label and/or question that you are addressing. Type using 12 pt. font on 8 '/z" X 11 " paper and number each page. A. ORGANIZATION CAPABILITY (Entire Section A not to exceed one page) 1 . Provide the mission statement and vision of your organization. Mission statement: CCCR will ensure the availability of high quality early childhood development and family support programs to lower-income, working families of Indian River County . The vision of CCCR is for childcare to be available and affordable for all children who qualify, and that the quality of childcare in Indian River County will be enhanced. In addition, parents will be able to work secure in the knowledge their children are thriving, and families will be strengthened and better able to nurture their children into responsible adulthood. CCCR envisions a community that embraces the mission and recognizes that community-wide support will improve the quality of life for all citizens . 2 . Provide a brief summary of your organization including areas of expertise, accomplishments, and population served. CCCR contracts with six local childcare centers located on eight sites, to deliver quality childcare programs for children from birth to kindergarten. CCCR serves working families who meet income eligibility guidelines . Centers must meet CCCR standards of quality . A team of early childhood professionals are involved in the process of choosing and assessing centers . Once accepted as a new provider, a center has provisional status for a period of at least one year . Centers receive unannounced weekly monitoring visits . Staffs receive training and support, and center directors meet bi-monthly with CCCR staff to discuss issues that affect the delivery of a quality program. The criteria for contracting include : a program which is both age and individually appropriate ; specifically trained and adequately compensated teachers ; low adult to child ratios ( 1 : 10 for preschool) ( 1 : 8 for 2 yr. olds) ( 1 : 6 for toddlers) ( 1 : 4 for infants) ; close ties with families and meaningful parental involvement; and access to comprehensive services. They are reimbursed at a rate to support the required standards . CCCR' s program places emphasis upon a strong family support and education component, including parenting workshops, parent/child interactive Saturday programs , parent support groups, . mentoring , resource and referral, and professional psychological clinical support. Children ' s progress is monitored and documented . There is parental choice among centers . Parents sign a contract committing to a sliding fee scale, and mandatory participations in orientations, parent/teacher conferences and parent education programs throughout the year. CCCR conducts fundraising and promotes public awareness , which are vital to the support, sustainability, and delivery of the program. Be PROGRAM NEED STATEMENT (Entire Section B not to exceed one page) Application for 2005 -2006 service period 4 Community Child Care Resources, Inc. Psychological Services Children 's Services Advisory Committee a) What is the unacceptable condition requiring change? b) Who has the need ? c) Where do they live? d) Provide local, state, or national trend data, with reference source, that corroborates that this is an area of need. a. A percentage of all families face problems and stresses and need professional psychological intervention. Recent research indicates that more children three and under suffer from emotional stress, like adults, "but they lack the coping mechanisms years of living bring" (Florida Association for Infant Mental Health, 2003 ) . CCCR' s targeted population is more economically needy, and families historically face life challenges to a greater degree than the general population. Consequently, they exhibit a greater need for psychological support. Indian River County lacks sufficient psychological services to serve low-income families with mental health needs . In addition, there are challenges in identifying families with such needs and encouraging them to take advantage of available resources . CCCR centers lack clinical staff and the financial resources to independently contract with mental health professionals . Problems in the classroom that cannot be handled within the capabilities of the staff often result in the expulsion of the child in crisis . Teacher requests for therapeutic intervention center on the number of children (total class , not just CCCR) exhibiting inappropriate anger towards both fellow students and teachers . CCCR staff has seen an increase in inappropriate anger in classrooms in recent years . On-site visits by therapists increase impact by helping the teacher develop a plan for work with the child who is angry and disruptive, restoring a productive environment and showing the other children in the class positive strategies for dealing with anger. b . The targeted population is CCCR families who demonstrate a need for psychological services in one or more of the following areas : 1 ) Children who exhibit behavioral, developmental, and/or emotional difficulties that seriously impact their chances for school and life success . 2) Parents who deal with issues like : abuse, divorce, depression, anxiety, custody, substance abuse or significant health problems . 3) Parents with "special needs" children in the family who need support. 4) CCCR centers need the opportunity to receive on- site professional psychological/behavioral support. c. Those in need appear to be spread evenly throughout Indian River County. d . The National Mental Health Association tells us that although one in five children ahs a diagnosable mental health problem, nearly two-thirds of them get little or no help . Untreated mental health problems can disrupt children ' s functioning at home, school and in the community. Without treatment, children with mental health issues are at increased risk of school failure, contact with the criminal justice system, dependence on social services, and even suicide . In the 2003 -2004 funding year, CCCR provided childcare for 97 children (85 slots) . 29 classroom visits from a professional therapist were required. This is up from eight in the previous year. We believe this is evidence of an increasing acceptance on the part of the centers and parents for professional intervention and increasing evidence of the need for such services . It should be remembered that professional services are only recommended after efforts by the CCCR staff and center staff have been exhausted . 1 . a) Identify similar programs that are currently serving the needs of your targeted population ; b) Explain how these existing programs are under-serving the targeted population of your program . a. CCCR and the School Readiness Coalition are the only programs in the County that tie psychological services , including direct intervention to the funding of childcare . b . The School Readiness Coalition has $2 , 500 in enhancement money to be used exclusively for direct services to individual children in their program . This would provide 30 hours of therapy, for Coalition children, and is unable to include family support. Application for 2005 -2006 service period 5 EXHIBIT A (Copy of complete Request for Proposal ) EXHIBIT - A - Community Child Care Resources, Inc. Psychological Services Children's Services Advisory Committee Co PROGRAM DESCRIPTION (Entire Section C, 1 — 6, not to exceed two pages) 1 . List Priority Needs area addressed. Mental Health Wellness 1 . Increasing programs that promote enhanced emotional-social skills . 2 . Increasing early intervention for borderline children- physical/emotional. 2 . Briefly describe program activities including location of services . a. All referrals start with the CCCR Family Resource Coordinator (FRC) , who conferences with the parent to assess the problem, along with the need for intervention. Already-employed strategies and resources will be reviewed and recorded b. Once need is established, the FRC secures authorization for the referral from the Executive Director (E. D . ) c . Parents select a therapist from a list of appropriate CCCR providers, and give written consent for information sharing d . The E. D . contacts the selected provider about CCCR' s funding criteria and reporting requirements e . Families with medical insurance use those benefits first. Families pay the therapist a $ 5 . 00 fee for each visit f. The FRC monitors the treatment plan through regular conferences with families, and consults with providers (as appropriate) e. The FRC facilitates recommended changes in the child' s individual school program, and with the classroom teacher monitors progress f. Services are provided at the office of the selected therapist or at the Centers . Psychological� Support to Centers : a. Contracting CCCR therapist allots 2-3 hour time blocks to CCCR centers with documented need . Purpose : work with classroom teachers on behavioral issues that may be interfering with social and/or cognitive learning in the classroom b . A teacher completes the pre-observation form prior to therapist visit. The therapist records observations, conferences with teacher, gives written strategies and sets date for follow-up c. The FRC follows-up to help the classroom teacher implement and evaluate program changes 3. Briefly describe how your program addresses the stated need/problem . Describe how your program follows a recognized "best practice" (see definition on page 12 of the Instructions) and provide evidence that indicates proposed strategies are effective with target population . CCCR recognizes that research indicates parent support and education are vital to a child ' s successful preschool experience . A child ' s development does not end when he leaves the classroom . The child that goes home to a dysfunctional family will not thrive . CCCR' s Psychological Support Services component is often the only source of professional intervention for families . Dollars are best spent on childcare, when the child is able to return home to a functional family, capable of positively reinforcing, nurturing and appreciating the child. 12 individuals sought treatment last year (28 individual sessions . ) . All showed improvement in their Global Assessment of Function Scores , compared to 82 % the previous year . Three years ago , CCCR developed a component to the Psychological Support Program that provided every CCCR classroom the opportunity for site visits by contracting therapists . The therapist worked with the entire classroom, and did not counsel individual children. In an end-of-year survey, center directors indicated that the positive impact on classroom behavior was significant. They indicated that teachers were less frustrated and seemed more willing to try new strategies . The percent of children exhibiting behavioral concerns in the classroom dropped from 29% in Fall of 2001 to 12% in Fall of 2002 to 6% in the Fall of Application for 2005 -2006 service period 6 Community Child Care Resources, Inc. Psychological Services Children 's Services Advisory Committee 2003 , as evidenced by Devereux Early Childhood Assessment screenings. Although our results do not weigh all mitigating factors, classroom intervention hada positive impact. 4. List staffing needed for your program, including required experience and estimated hours per week in program for each staff member and/or volunteers (this section should conform with the information in the Position Listing on the Budget Narrative Worksheet). Professional Staff: Executive Director : ( 1 ) On average 8 hours per week are devoted to program. Experience/expertise in : securing and distributing funding for the program, monitoring compliance regarding reporting and billing procedures, maintaining a "bank" of quality therapists to serve families at a reduced hourly billing rate . Family Resource Coordinator: ( 1 ) On average 10 hours per week are devoted to program . Experience/ Expertise in: assessing referrals, monitoring treatment plans, implementing program changes in the classroom serving as a liaison among parents, therapists, and centers . Support Staff: Office Manager: ( 1 ) On average 4 hours per week is devoted to the program . Experience/expertise in: processing invoices from providers, monitoring parent compliance regarding fee payments, checking family health insurance benefits . 5. How will the target population be made aware of the program ? CCCR families are made aware of the psychological support program during intake, at the CCCR orientation, and individually through the Family Resource Coordinator. In addition, Center Staffs are aware of the availability of the program, and refer families in need. One of the challenges of psychological support is encouraging referred families to participate . Due to challenges in the past year, CCCR will have therapists available for the second year at orientation to introduce them to parents, and they will talk to Center Directors to encourage staff to support referred families to participate. Parents who have benefited from the counseling services will be invited to share their experience with incoming parents as well . How will the program be accessible to target population (i. e. , location, transportation, hours of operation) ? Within the parameters of therapist specialty, there is parental choice . This enables a parent to choose a therapist convenient to home or work. Some contracting therapists have evening and weekend appointments available for CCCR families . Some contracting therapists are willing to hold individual therapy sessions at the child ' s center. Some therapists are willing to hold individual therapy sessions in a separate office at the CCCR facility. Parents unable to pay the $ 5 . 00 fee may have it waved through CCCR ' s program committee . Application for 2005 -2006 service period 7 Community Child Care Resources, Inc. Psychological Services Children 's Services Advisory Committee PROGRAM COVER PAGE Organization Name : Community Child Care Resources, Inc . Executive Director: Pamela C . King E-mail :pkingcccr@bellsouth.net Address : 1801 24`h Street Telephone : 567-3202 Vero Beach, Florida 32960 Fax : 567- 1136 Program Director: Same as above E-mail : Program Title : Psychological Services L1 Lj. Priority Need Area Addressed: MENTAL WELLNESS ISSUES : 1 . Increasing programs that promote emotional-social skills . 2 . Increasing early intervention services for "borderline" children — physical-emotional . Brief Description of the Program : This program provides parent counseling (RP450 . 650) and in- person crisis intervention (RP- 150 . 330) services to CCCR families and contracting centers . Families receive individual and/or family therapy from various contracting CCCR mental health professionals . Centers receive classroom support through site visits by therapists specializing in early childhood. children. SUMMARY REPORT — ffnter Information In The Black Cells Only) Current Program Funding ( 2004 / 05 ) : $ Dollar increase / ( decrease ) in request : $ _ . . _.. ._.. . . ... _..._. ......._....... Percent increase /( decrease ) in re uest * * 0 . 0 % Unduplicated Number of Children to be served Individually : 25 Unduplicated Number of I Adults to be served Individually : _ Unduplicated Number to be served via Group settings : 1 72 Total Program Cost per Client : 407 . 46 * * If request increased 5 % or more, briefly explain why : Centers have not received an increase in daily rates in nine years . To retain high quality care, childcare centers need to receive commensurate compensation. If these funds are being used to match another source, name the source and the $ amount : United Way, Success by Six : $4, 000 . 00 , / Organization 's Board of Directors has approved this application on e . Gla -6 2005 Thomas C . Yonge Name of President/Chair of the Board Si natu v Pamela C . King P, l\ , Name of Executive Director/CEO Signature Application for 2005 -2006 service period 3 Community Child Care Resources, Inc. Psychological Services Children's Services Advisory Committee D. MEASURABLE OUTCOMES (Entire Section D not to exceed two pages) OUTCOMES ACTIVITIES Add all of the elements or the Measurable Outcome(s) Add the tasks to accomplish the Outcome(s) 1 . To increase the number of referred families in 1 . Therapists will be introduced to families during active treatment by 5 % during the 2004-2005 CCCR and Center orientations . CCCR service school year, as measured by the number of options will be described completed Mental Health Provider Forms . 2 . Therapists will come to Center Director Baseline : Family Resource Coordinator ' s meeting to encourage their staff to talk to Psychological Referrals log . referred parents about the value of the services 3 . Referrals start with the CCCR Family Resource Coordinator (FRC) , who talks with the parent to assess the problem and need for intervention 4 . Once need is established, the FRC secures referral authorization from the Executive Director (E. D .) 5 . Parents select a therapist from a list of CCCR providers appropriate to address the problem, and give written consent for sharing of information 6 . The E . D . communicates CCCR' s funding criteria and reporting requirements to the provider 7 . Families with medical insurance will use those benefits first. Families pay a $ 5 . 00 "out of pocket" charge directly to the therapist. If the family can ' t afford the co -pay, the FRC will refer the case to the Program Committee who may waive the fee . 8 . Families schedule an initial appointment with the therapist. 9 . The FRC will remain in weekly contact with the parent to encourage the parent to call for an appointment . 1 . The therapist designs a treatment plan, and the family takes responsibility for the scheduling of all appointments . 2 . 85 % of individuals attending more than two 2 . The FRC monitors the treatment plan through therapy sessions will raise their Global Assessment regular conferences with the family, and of Functioning (GAF) within the 2004-2005 school consults informally with therapists as year, as measured by the Discharge GAF score . appropriate . Baseline : Admission GAF score . 3 . The FRC facilitates any recommended changes in the child ' s individual school program, and, with the classroom teacher monitors progress . Application for 2005 -2006 service period 8 Community Child Care Resources, Inc. Psychological Services Children 's Services Advisory Committee 3 . To increase school readiness through a 10% 1 . Classroom teacher completes a request for increase in appropriate behavior in classrooms psychological services (Observation report), and receiving intervention as measured by initial documents specific inappropriate behaviors classroom teacher report and therapist observation requiring intervention. report 2 . The contracting CCCR therapist schedules two- hour time blocks . Baseline : Classroom observation report for 3 . During the first visit, the Psychological Services psychological services and Therapist Classroom Classroom Report is completed. Services Report 4 . The therapist works with the teacher to enhance the classroom environment, and supports the teacher with behavioral concerns . 6 . The therapist helps the teacher develop a behavior management plan, and conferences with the Center Director regarding implementation of the plan. 7. The CCCR Family Resource Coordinator (FRC) follows-up on a regular basis with the classroom teacher to help implement, adjust and evaluate the plan . 8 . If needed, the therapist makes additional visits and/or suggestions for individual child referrals . Application for 2005 -2006 service period 9 Community Child Care Resources, Inc. Psychological Services Children 's Services Advisory Committee PROPOSAL NARRATIVE Please respond to each question in the allotted space for each section. In responding to each section of the proposal narrative, please retain the section-label and/or question that you are addressing. Type using 12 pt. font on 8 '/z" X 11 " paper and number each page. A. ORGANIZATION CAPABILITY (Entire Section A not to exceed one page) 1 . Provide the mission statement and vision of your organization. Mission statement: CCCR will ensure the availability of high quality early childhood development and family support programs to lower-income, working families of Indian River County . The vision of CCCR is for childcare to be available and affordable for all children who qualify, and that the quality of childcare in Indian River County will be enhanced. In addition, parents will be able to work secure in the knowledge their children are thriving, and families will be strengthened and better able to nurture their children into responsible adulthood. CCCR envisions a community that embraces the mission and recognizes that community-wide support will improve the quality of life for all citizens . 2 . Provide a brief summary of your organization including areas of expertise, accomplishments, and population served. CCCR contracts with six local childcare centers located on eight sites, to deliver quality childcare programs for children from birth to kindergarten. CCCR serves working families who meet income eligibility guidelines . Centers must meet CCCR standards of quality . A team of early childhood professionals are involved in the process of choosing and assessing centers . Once accepted as a new provider, a center has provisional status for a period of at least one year . Centers receive unannounced weekly monitoring visits . Staffs receive training and support, and center directors meet bi-monthly with CCCR staff to discuss issues that affect the delivery of a quality program. The criteria for contracting include : a program which is both age and individually appropriate ; specifically trained and adequately compensated teachers ; low adult to child ratios ( 1 : 10 for preschool) ( 1 : 8 for 2 yr. olds) ( 1 : 6 for toddlers) ( 1 : 4 for infants) ; close ties with families and meaningful parental involvement; and access to comprehensive services. They are reimbursed at a rate to support the required standards . CCCR' s program places emphasis upon a strong family support and education component, including parenting workshops, parent/child interactive Saturday programs , parent support groups, . mentoring , resource and referral, and professional psychological clinical support. Children ' s progress is monitored and documented . There is parental choice among centers . Parents sign a contract committing to a sliding fee scale, and mandatory participations in orientations, parent/teacher conferences and parent education programs throughout the year. CCCR conducts fundraising and promotes public awareness , which are vital to the support, sustainability, and delivery of the program. Be PROGRAM NEED STATEMENT (Entire Section B not to exceed one page) Application for 2005 -2006 service period 4 Community Child Care Resources, Inc. Psychological Services Children 's Services Advisory Committee a) What is the unacceptable condition requiring change? b) Who has the need ? c) Where do they live? d) Provide local, state, or national trend data, with reference source, that corroborates that this is an area of need. a. A percentage of all families face problems and stresses and need professional psychological intervention. Recent research indicates that more children three and under suffer from emotional stress, like adults, "but they lack the coping mechanisms years of living bring" (Florida Association for Infant Mental Health, 2003 ) . CCCR' s targeted population is more economically needy, and families historically face life challenges to a greater degree than the general population. Consequently, they exhibit a greater need for psychological support. Indian River County lacks sufficient psychological services to serve low-income families with mental health needs . In addition, there are challenges in identifying families with such needs and encouraging them to take advantage of available resources . CCCR centers lack clinical staff and the financial resources to independently contract with mental health professionals . Problems in the classroom that cannot be handled within the capabilities of the staff often result in the expulsion of the child in crisis . Teacher requests for therapeutic intervention center on the number of children (total class , not just CCCR) exhibiting inappropriate anger towards both fellow students and teachers . CCCR staff has seen an increase in inappropriate anger in classrooms in recent years . On-site visits by therapists increase impact by helping the teacher develop a plan for work with the child who is angry and disruptive, restoring a productive environment and showing the other children in the class positive strategies for dealing with anger. b . The targeted population is CCCR families who demonstrate a need for psychological services in one or more of the following areas : 1 ) Children who exhibit behavioral, developmental, and/or emotional difficulties that seriously impact their chances for school and life success . 2) Parents who deal with issues like : abuse, divorce, depression, anxiety, custody, substance abuse or significant health problems . 3) Parents with "special needs" children in the family who need support. 4) CCCR centers need the opportunity to receive on- site professional psychological/behavioral support. c. Those in need appear to be spread evenly throughout Indian River County. d . The National Mental Health Association tells us that although one in five children ahs a diagnosable mental health problem, nearly two-thirds of them get little or no help . Untreated mental health problems can disrupt children ' s functioning at home, school and in the community. Without treatment, children with mental health issues are at increased risk of school failure, contact with the criminal justice system, dependence on social services, and even suicide . In the 2003 -2004 funding year, CCCR provided childcare for 97 children (85 slots) . 29 classroom visits from a professional therapist were required. This is up from eight in the previous year. We believe this is evidence of an increasing acceptance on the part of the centers and parents for professional intervention and increasing evidence of the need for such services . It should be remembered that professional services are only recommended after efforts by the CCCR staff and center staff have been exhausted . 1 . a) Identify similar programs that are currently serving the needs of your targeted population ; b) Explain how these existing programs are under-serving the targeted population of your program . a. CCCR and the School Readiness Coalition are the only programs in the County that tie psychological services , including direct intervention to the funding of childcare . b . The School Readiness Coalition has $2 , 500 in enhancement money to be used exclusively for direct services to individual children in their program . This would provide 30 hours of therapy, for Coalition children, and is unable to include family support. Application for 2005 -2006 service period 5 Community Child Care Resources, Inc. Psychological Services Children's Services Advisory Committee E. COLLABORATION (Entire Section E not to exceed one page) 1 . List your program ' s collaborative partners and the resources that they are providing to the program beyond referrals and support. (See individual funder requirements for inclusion of collaborative agreement letters. Collaborative Agency Resources provided to the program CCCR Contracting Therapists : All CCCR therapists discount their hourly rate Linda Asher, Ph.D . approximately 29% . Some provide evening and Madeleine Laplante, M . A. , LMHC weekend hours . Some provide service at the child ' s Therese Cirner, M .A . NCC center. All complete the appropriate Mental Health Brent A. Jeremy, L . C . S . W. Provider Forms or Psychological Support Classroom Dr. Judith Siegler, Family Therapist Report Forms . Dr. Robert Brugnoli , Psychologist Community Church Partner' s The Partner ' s program can transport CCCR families that Program they are working with to and from therapy appointments . The mentor will go with the parent to an initial appointment, if so desired. The Partner' s Program will pay for any medication that may be prescribed, if the parent cannot afford it. In addition, they will provide babysitting so a parent may go to a therapy appointment. Indian River Public Schools and Conduct diagnostic screening on CCCR children who Florida Diagnostic & Learning have .learning and behavioral concerns . The data is then Resources System (FDLRS) used by the CCCR therapist to design a treatment plan. Indian River Early Learning Coalition CCCR manages psychological enhancement dollars for the Early Learning Coalition. CCCR coordinates referrals and therapist placements . The CCCR Mental Health provider Form , the Initial Classroom Observation Report, and the Psychological Services Survey are used by the Coalition . The collaboration provides direct psychological services for subsidized families and increased revenue for CCCR therapists willing to reduce rates for both programs . Application for 2005 -2006 service period 10 Community Child Care Resources, Inc. Psychological Services Children's Services Advisory Committee a. PROGRAM EVALUATION (Entire Section F not to exceed two pages) 2 DEMOGRAPHICS : What information (data elements) will you need to collect in order to accurately describe your target population including demographics (age, gender, and ethnic background) required by the funder in Section H? What are the pieces of information that qualify them for your target population ? How do you document their need for services or their "unacceptable condition requiring change" from Section B19 Data Elements Describing "Services to Families " Target Population a. Source of referral — (center, parent, CCCR, outside agency) b . Form of treatment plan — (child, parent, couple, family) c . Diagnostic code (DX) number d . Admission Global Assessment of Functioning (GAF) number e. Anticipated number of service units that will be needed Data Elements Describing "Services to Classrooms " target Population a. Number of children exhibiting behavioral concerns b. Number of children scoring below standard norms on DECA assessment C, Type and number of unsuccessful teacher interventions prior to requesting services d. Type and number of teacher requests for service in individual centers e. Number of service units used per classroom f. Number of children referred for individual therapy 2. MEASURES : What data elements will you need to collect to show that you have achieved (or made progress toward) your Measurable Outcomes in Section D ? What tools or items are you using as measures (grades, survey scores , attendance, absences , skill levels) for your program ? Are you getting baseline information from a source on your Collaboration List in Section E ? Are there results from your Activities in Section D that need to be documented ? How often do you need to collect or follow-up on this data ? Services to Families " Measurement Elements a. The number of referrals made for psychological services will be collected by the Family Resource Coordinator (FRC) and compiled in the Psychological Services Log b Mental Health Provider Forms completed by the therapist will be collected quarterly and compiled in the Psychological Services Log . The form documents admission and discharge GAF ' s , Diagnosis Codes and descriptions, # of appointments made , kept, cancelled and "no Show", anticipated length of treatment, and other outside resources being used . Services to Classrooms " Measurement Elements a. Fall and spring DECA assessment scores will be collected in November and May and compiled in the Psychological Services Log . b . The numbers and types of classroom concerns are collected through the completion of the Teacher Observation Forms . They are submitted along with the Psychological Support Classroom Report Form to the FRC who compiles them in the psychological Services log . c. The Psychological Support Classroom Report form is completed by the therapist and submitted to the FRC (compiled in Psychological Services Log) . This form documents type and severity of behavioral concerns observed, description of strategies to be implemented, and the expected need for follow-up by the therapist to the classroom. Application for 2005 -2006 service period 11 Community Child Care Resources, Inc. Psychological Services Children's Services Advisory Committee Co PROGRAM DESCRIPTION (Entire Section C, 1 — 6, not to exceed two pages) 1 . List Priority Needs area addressed. Mental Health Wellness 1 . Increasing programs that promote enhanced emotional-social skills . 2 . Increasing early intervention for borderline children- physical/emotional. 2 . Briefly describe program activities including location of services . a. All referrals start with the CCCR Family Resource Coordinator (FRC) , who conferences with the parent to assess the problem, along with the need for intervention. Already-employed strategies and resources will be reviewed and recorded b. Once need is established, the FRC secures authorization for the referral from the Executive Director (E. D . ) c . Parents select a therapist from a list of appropriate CCCR providers, and give written consent for information sharing d . The E. D . contacts the selected provider about CCCR' s funding criteria and reporting requirements e . Families with medical insurance use those benefits first. Families pay the therapist a $ 5 . 00 fee for each visit f. The FRC monitors the treatment plan through regular conferences with families, and consults with providers (as appropriate) e. The FRC facilitates recommended changes in the child' s individual school program, and with the classroom teacher monitors progress f. Services are provided at the office of the selected therapist or at the Centers . Psychological� Support to Centers : a. Contracting CCCR therapist allots 2-3 hour time blocks to CCCR centers with documented need . Purpose : work with classroom teachers on behavioral issues that may be interfering with social and/or cognitive learning in the classroom b . A teacher completes the pre-observation form prior to therapist visit. The therapist records observations, conferences with teacher, gives written strategies and sets date for follow-up c. The FRC follows-up to help the classroom teacher implement and evaluate program changes 3. Briefly describe how your program addresses the stated need/problem . Describe how your program follows a recognized "best practice" (see definition on page 12 of the Instructions) and provide evidence that indicates proposed strategies are effective with target population . CCCR recognizes that research indicates parent support and education are vital to a child ' s successful preschool experience . A child ' s development does not end when he leaves the classroom . The child that goes home to a dysfunctional family will not thrive . CCCR' s Psychological Support Services component is often the only source of professional intervention for families . Dollars are best spent on childcare, when the child is able to return home to a functional family, capable of positively reinforcing, nurturing and appreciating the child. 12 individuals sought treatment last year (28 individual sessions . ) . All showed improvement in their Global Assessment of Function Scores , compared to 82 % the previous year . Three years ago , CCCR developed a component to the Psychological Support Program that provided every CCCR classroom the opportunity for site visits by contracting therapists . The therapist worked with the entire classroom, and did not counsel individual children. In an end-of-year survey, center directors indicated that the positive impact on classroom behavior was significant. They indicated that teachers were less frustrated and seemed more willing to try new strategies . The percent of children exhibiting behavioral concerns in the classroom dropped from 29% in Fall of 2001 to 12% in Fall of 2002 to 6% in the Fall of Application for 2005 -2006 service period 6 Community Child Care Resources, Inc. Psychological Services Children 's Services Advisory Committee 2003 , as evidenced by Devereux Early Childhood Assessment screenings. Although our results do not weigh all mitigating factors, classroom intervention hada positive impact. 4. List staffing needed for your program, including required experience and estimated hours per week in program for each staff member and/or volunteers (this section should conform with the information in the Position Listing on the Budget Narrative Worksheet). Professional Staff: Executive Director : ( 1 ) On average 8 hours per week are devoted to program. Experience/expertise in : securing and distributing funding for the program, monitoring compliance regarding reporting and billing procedures, maintaining a "bank" of quality therapists to serve families at a reduced hourly billing rate . Family Resource Coordinator: ( 1 ) On average 10 hours per week are devoted to program . Experience/ Expertise in: assessing referrals, monitoring treatment plans, implementing program changes in the classroom serving as a liaison among parents, therapists, and centers . Support Staff: Office Manager: ( 1 ) On average 4 hours per week is devoted to the program . Experience/expertise in: processing invoices from providers, monitoring parent compliance regarding fee payments, checking family health insurance benefits . 5. How will the target population be made aware of the program ? CCCR families are made aware of the psychological support program during intake, at the CCCR orientation, and individually through the Family Resource Coordinator. In addition, Center Staffs are aware of the availability of the program, and refer families in need. One of the challenges of psychological support is encouraging referred families to participate . Due to challenges in the past year, CCCR will have therapists available for the second year at orientation to introduce them to parents, and they will talk to Center Directors to encourage staff to support referred families to participate. Parents who have benefited from the counseling services will be invited to share their experience with incoming parents as well . How will the program be accessible to target population (i. e. , location, transportation, hours of operation) ? Within the parameters of therapist specialty, there is parental choice . This enables a parent to choose a therapist convenient to home or work. Some contracting therapists have evening and weekend appointments available for CCCR families . Some contracting therapists are willing to hold individual therapy sessions at the child ' s center. Some therapists are willing to hold individual therapy sessions in a separate office at the CCCR facility. Parents unable to pay the $ 5 . 00 fee may have it waved through CCCR ' s program committee . Application for 2005 -2006 service period 7 Community Child Care Resources, Inc. Psychological Services Children's Services Advisory Committee 3 . REPORTING : What will you do with this information to show that change has occurred? How will you use or present these results to the consumer, the funder, the program, and the community? How will you use this information to improve your program ? Services to Families- Reporting Change a. The number of referrals for service will be compared with the number of Mental Health Provider Forms completed . This will document the percent of families following through on referral . b . Data collected from the Mental Health Provider Form is used to compare the patient ' s level of functioning before and after treatment. This will document the percent of patients who raised their GAF scores. Services to Classrooms- Reporting Change a. The Teacher Pre-Observation Form serves as a baseline in determining change . b . The Psychological Services Classroom Report Form documents areas to be addressed and strategies to be implemented. Sharing Results With the Consumer: Historical data about the percentage of CCCR families using psychological services are used as a "marketing tool" to help current CCCR families become comfortable asking for help . Therapists will be involved in future family orientations to describe the type of help they can offer through CCCR. Individually, therapists can help parents and children see what they have accomplished. DECA results are interpreted for parents during conferences to better describe how the child functions in a group , and the child' s status with social/emotional development With the Funder: Results are used to show progress and measure success . Generally presented in chart form, they document that the program delivers the services for which it is being funded . With the Program : Results are used by Board and staff to validate that the mission is being carried forward . Evaluative information helps target areas for improvement and growth. With the Community: Sharing measurable results about your program leads to community awareness that in turn may lead to new sources of funding . Outcome success also results in attracting quality people to your organization. Application for 2005 -2006 service period 12 Community Child Care Resources, Inc. Psychological Services Children 's Services Advisory Committee G. TIMETABLE (Section G not to exceed one page) 1 . List the major action steps , activities, or cycles of events that will occur within the program year. New programs should include any start-up planning that may occur outside the fundingyear. In completing the timetable, review information detailed in prior sections. Month/Period Activities Psychological Support to Children and Families 1 . Ongoing 1 . Referral and authorization process 2 . Ongoing 2 , Treatment 3 . Ongoing 3 . Family Resource Coordinator monitors treatment plan with therapist and shares as appropriate with Center, 4 . December and April 4. Mental Health Provider Forms completed by therapists. 5 . January and May 5 , Mental Health Provider Forms reviewed by Program Committee 6 . At discharge 6 . Client satisfaction survey completed by parent Psychological Support to Centers 1 . Ongoing 1 . Documentation of need for clinical classroom support 2 . Prior to Visit by therapist 2 . Teacher completes classroom report prior to- , observation for psychological services provider 3 . Day of Visit 3 . Therapist completes Psychological Services Classroom Report 4 . Day of Visit 4 . Behavior Management Plan put in place 5 . Ongoing 5 . Family Resource Coordinator conducts classroom follow-up . 6 . December and May 6 . Psychological Services Classroom Report reviewed by Program Committee Application for 2005 -2006 service period 13 Community Child Care Resources, Inc. Psychological Services Children's Services Advisory Committee D. MEASURABLE OUTCOMES (Entire Section D not to exceed two pages) OUTCOMES ACTIVITIES Add all of the elements or the Measurable Outcome(s) Add the tasks to accomplish the Outcome(s) 1 . To increase the number of referred families in 1 . Therapists will be introduced to families during active treatment by 5 % during the 2004-2005 CCCR and Center orientations . CCCR service school year, as measured by the number of options will be described completed Mental Health Provider Forms . 2 . Therapists will come to Center Director Baseline : Family Resource Coordinator ' s meeting to encourage their staff to talk to Psychological Referrals log . referred parents about the value of the services 3 . Referrals start with the CCCR Family Resource Coordinator (FRC) , who talks with the parent to assess the problem and need for intervention 4 . Once need is established, the FRC secures referral authorization from the Executive Director (E. D .) 5 . Parents select a therapist from a list of CCCR providers appropriate to address the problem, and give written consent for sharing of information 6 . The E . D . communicates CCCR' s funding criteria and reporting requirements to the provider 7 . Families with medical insurance will use those benefits first. Families pay a $ 5 . 00 "out of pocket" charge directly to the therapist. If the family can ' t afford the co -pay, the FRC will refer the case to the Program Committee who may waive the fee . 8 . Families schedule an initial appointment with the therapist. 9 . The FRC will remain in weekly contact with the parent to encourage the parent to call for an appointment . 1 . The therapist designs a treatment plan, and the family takes responsibility for the scheduling of all appointments . 2 . 85 % of individuals attending more than two 2 . The FRC monitors the treatment plan through therapy sessions will raise their Global Assessment regular conferences with the family, and of Functioning (GAF) within the 2004-2005 school consults informally with therapists as year, as measured by the Discharge GAF score . appropriate . Baseline : Admission GAF score . 3 . The FRC facilitates any recommended changes in the child ' s individual school program, and, with the classroom teacher monitors progress . Application for 2005 -2006 service period 8 Community Child Care Resources, Inc. Psychological Services Children 's Services Advisory Committee 3 . To increase school readiness through a 10% 1 . Classroom teacher completes a request for increase in appropriate behavior in classrooms psychological services (Observation report), and receiving intervention as measured by initial documents specific inappropriate behaviors classroom teacher report and therapist observation requiring intervention. report 2 . The contracting CCCR therapist schedules two- hour time blocks . Baseline : Classroom observation report for 3 . During the first visit, the Psychological Services psychological services and Therapist Classroom Classroom Report is completed. Services Report 4 . The therapist works with the teacher to enhance the classroom environment, and supports the teacher with behavioral concerns . 6 . The therapist helps the teacher develop a behavior management plan, and conferences with the Center Director regarding implementation of the plan. 7. The CCCR Family Resource Coordinator (FRC) follows-up on a regular basis with the classroom teacher to help implement, adjust and evaluate the plan . 8 . If needed, the therapist makes additional visits and/or suggestions for individual child referrals . Application for 2005 -2006 service period 9 o4i W (7*, CIA PC tI 1 1 I I 1 1 o . It fit � L C I I 1 I I I I I I 1 CIN �[ \ Nta I 1 1 N 1 1 1 N W y Jill" I MY 00 00 00 a3 6l 2P'd 5�6Y" Ov t� 00 N 1 I 1 1 I I d 01 CN O ONO a aU *6 o N i . /PC T M." @g�'�� Wool N o 13 y ��1 b9lU ? }hTT _ q pa U o U _ a `�' as U •� ,-a° ,� 1 C�o I r��n • `" r � , � � oIn -4 kr) °, o Type the Organization and Program Name Example: Executive Director/ 40hrs 70, 000.00 101000.00 5,000.00 7. 14% Executive Director/ 40 hours 46, 800. 00 99360. 00 0.00° Family Resource Coordinator/ 40 hours 37,312 . 76 9,328. 19 p,pp° Bookkeeper/ 40 hours 28 , 121 .60 21812. 16 0.00% #DIV/0! #DIV/0! #DIV/0! #DIV/0 ! #DIV/0 ! #DIV/0! #DIV/0! #DIV/0! #DIV/0 ! #DIV/0! #DIV/0 ! #DIV/0 ! #DIV/0! #DIV/0! #DIV/0! #DIV/0! Remaining positions throughout the agency #DIV/01 Total Salaries $ 112,234 .361 $21 , 500 . 35 $0.001 0.00% FRINGE BENEFITS DETAIL A (Funder Specific Budget . Funder B c D E F G S cific FICA 7.65% Pension Worker's Unemph>yme Total Fringes Funder Column C only, from line 22 to 27) p (A x %) Health Ins. Compens, nt Compens. Specific Position Title / Total Hrs/wk Budget Example: Case Manager / 4ohrs 51000. 00 382. 50 200. 00 500.00 300. 00 200. 00 11582.50 Executive Director/ 40 hours 0 . 00 0.00 0. 0 Family Resource Coordinator/ 40 hours 0 . 00 0.00 0. 0 Bookkeeper/ 40 hours 0 . 00 0.00 0. 0 0 0 . 00 0.00 0. 0 0 0. 001 0.00 0. 0 0 0. 001 0. 00 0. 0 0 0.00 0 . 00 0.00 0 0 .00 0 . 00 0.0 0 0.00 0 . 00 0. 0 0 0 . 00 0. 00 0 .0 0 0. 00 0. 001 0.0 0 - --0.001 0. 001111 0 .0 0 0 . 001 0. 00 0.0 0 0 . 001 0. 00 0.0 0 0. 001 0. 00 0.0 0 0 . 001 0. 00 1 0. 0 0 0. 001 0. 00 0. 001 0 0. 001 0 .00 0. 0 0 0. 00 0 . 00 0. 001 0 0. 001 0 . 00 0. 001 Total Funder Request Fringe Benefits $ . 001 $0 . 00 $0. 00 $0 . 00 $0 . 00 $0 . 00 $0 . 0 A B C D EXPENDITURES GRAY AREAS FOR Proposed Total Program Funder Specific Total Agency AGENCY USE ONLY TO SHOW DETAIL Budget Budget Budget 27 Travel-Daily 20 . 00 0 . 00 21500. 00 # of Staff x average # of miles/wk x 50 wks x $ = Estimated Daily Travel/Mileage Reimb . 28 Travel/Conferences/Training 0 . 001 0 . 00 11000 . 00 5/13/2005 B-1 Community Child Care Resources, Inc. Psychological Services Children's Services Advisory Committee E. COLLABORATION (Entire Section E not to exceed one page) 1 . List your program ' s collaborative partners and the resources that they are providing to the program beyond referrals and support. (See individual funder requirements for inclusion of collaborative agreement letters. Collaborative Agency Resources provided to the program CCCR Contracting Therapists : All CCCR therapists discount their hourly rate Linda Asher, Ph.D . approximately 29% . Some provide evening and Madeleine Laplante, M . A. , LMHC weekend hours . Some provide service at the child ' s Therese Cirner, M .A . NCC center. All complete the appropriate Mental Health Brent A. Jeremy, L . C . S . W. Provider Forms or Psychological Support Classroom Dr. Judith Siegler, Family Therapist Report Forms . Dr. Robert Brugnoli , Psychologist Community Church Partner' s The Partner ' s program can transport CCCR families that Program they are working with to and from therapy appointments . The mentor will go with the parent to an initial appointment, if so desired. The Partner' s Program will pay for any medication that may be prescribed, if the parent cannot afford it. In addition, they will provide babysitting so a parent may go to a therapy appointment. Indian River Public Schools and Conduct diagnostic screening on CCCR children who Florida Diagnostic & Learning have .learning and behavioral concerns . The data is then Resources System (FDLRS) used by the CCCR therapist to design a treatment plan. Indian River Early Learning Coalition CCCR manages psychological enhancement dollars for the Early Learning Coalition. CCCR coordinates referrals and therapist placements . The CCCR Mental Health provider Form , the Initial Classroom Observation Report, and the Psychological Services Survey are used by the Coalition . The collaboration provides direct psychological services for subsidized families and increased revenue for CCCR therapists willing to reduce rates for both programs . Application for 2005 -2006 service period 10 Community Child Care Resources, Inc. Psychological Services Children's Services Advisory Committee a. PROGRAM EVALUATION (Entire Section F not to exceed two pages) 2 DEMOGRAPHICS : What information (data elements) will you need to collect in order to accurately describe your target population including demographics (age, gender, and ethnic background) required by the funder in Section H? What are the pieces of information that qualify them for your target population ? How do you document their need for services or their "unacceptable condition requiring change" from Section B19 Data Elements Describing "Services to Families " Target Population a. Source of referral — (center, parent, CCCR, outside agency) b . Form of treatment plan — (child, parent, couple, family) c . Diagnostic code (DX) number d . Admission Global Assessment of Functioning (GAF) number e. Anticipated number of service units that will be needed Data Elements Describing "Services to Classrooms " target Population a. Number of children exhibiting behavioral concerns b. Number of children scoring below standard norms on DECA assessment C, Type and number of unsuccessful teacher interventions prior to requesting services d. Type and number of teacher requests for service in individual centers e. Number of service units used per classroom f. Number of children referred for individual therapy 2. MEASURES : What data elements will you need to collect to show that you have achieved (or made progress toward) your Measurable Outcomes in Section D ? What tools or items are you using as measures (grades, survey scores , attendance, absences , skill levels) for your program ? Are you getting baseline information from a source on your Collaboration List in Section E ? Are there results from your Activities in Section D that need to be documented ? How often do you need to collect or follow-up on this data ? Services to Families " Measurement Elements a. The number of referrals made for psychological services will be collected by the Family Resource Coordinator (FRC) and compiled in the Psychological Services Log b Mental Health Provider Forms completed by the therapist will be collected quarterly and compiled in the Psychological Services Log . The form documents admission and discharge GAF ' s , Diagnosis Codes and descriptions, # of appointments made , kept, cancelled and "no Show", anticipated length of treatment, and other outside resources being used . Services to Classrooms " Measurement Elements a. Fall and spring DECA assessment scores will be collected in November and May and compiled in the Psychological Services Log . b . The numbers and types of classroom concerns are collected through the completion of the Teacher Observation Forms . They are submitted along with the Psychological Support Classroom Report Form to the FRC who compiles them in the psychological Services log . c. The Psychological Support Classroom Report form is completed by the therapist and submitted to the FRC (compiled in Psychological Services Log) . This form documents type and severity of behavioral concerns observed, description of strategies to be implemented, and the expected need for follow-up by the therapist to the classroom. Application for 2005 -2006 service period 11 Type the Organization and Program Name UNIFORM GRANT APPLICATION BUDGET NARRATIVE WORKSHEET IMPORTANT: The Budget Narrative should provide details to justify the amount requested in each line item of the budget for your program. From this worksheet, your figures will be linked to the Total Agency Budget, Total Program Budget and Funder Speck Budget Forms. AGENCY/PROGRAM NAME : Community Child Care Resources , Inc ./Psychological Services FUNDER : Advisory Committee-Indian River PAUTION : Do not enter any figures where a cell is colored in dark blue - Formulas and/or links are in place. Gray areas should j be a used for calculations and to write information only. ; GRAY AREAS FOR �77 NUMENEW'WE I REVENUES AGENCY USE ONLY Proposed Total Program Funder Specific Total Agency VJHO ' �) Budget Budget Budget 1 Children's Services Council-St Lucie 2 Children's Services Council-Martin 3 Advisory Committee-Indian River 79000.00 7,000 .00 207,000.00 4 United Way-St Lucie County 5 United Way-Martin County 6 United Way-Indian River County 4, 000.00 1919152 . 00 7 Department of Children & Families 8 County Funds CC, Found , 9 Contributions-Cash Churches , Org 16, 502 . 00 130,000.00 10 Program Fees Parent fee 7rO22.001 629000 . 00 11 Fund Raising Events-Net 5 ,000 . 00 300000.00 12 Sales to Public - Net 13 Membership Dues 14 Investment Income 15 Miscellaneous 16 Legacies & Bequests 17 Funds from Other Sources ALPI 12, 000. 00 18 Reserve Funds Used for Operating Shajara Found 5, 000.00 19 In-Kind Donations (Not Included in total) 51000.00 20 TOTAL REVENUES (doesn't include line 19) $39, 524 .00 $7,000.00 $6370152. 00 A B C D EXPENDITURES GRAY AREAS FOR Proposed Total Program Funder Specific Total Agency AGENCY USE ONLY (SHOW CALCULATIONS) Budget Budget Budget 21 Salaries - (must complete chart on next page) 21 , 500. 35 0. 00 112 ,234. 36 MFILUF 70 -- Salary 22 FICA - Total salaries x 0. 0765 7.65% 11644 . 78 0 . 00 81594 . 00 e firemen - Annual pensionor qua i )e 23 staff 0. 00 Life/H;alth - Medical/Dental/Short-term 24 Disab . 0.00 Workers Compensation - # employees x 25 rate 250 . 00 0. 00 1 ,064 . 00 ori a Unemployment - # projected 26 employees x $7 , 000 x UCT-6 rate 0 . 00 SALARIES A B D C % of Gross Annual POSITION LISTING Gross Annual Portion of salary on Proposed Salary Program Funder Specific Budget Salary Position Title / Total HrsAvk (Agency) Requested(CIA) 5/13/2005 B-1 Type the Organization and Program Name Example: Executive Director/ 40 hrs 70,000.00 10,000.00 51000.00 7.14% Executive Director/ 40 hours 46, 800.00 99360.00 0.00° Family Resource Coordinator/ 40 hours 37,312 .76 9,328. 19 0.00° Bookkeeper/ 40 hours 281121 .60 2,812. 16 0.00° #DIV/O! #DIV/0! #DIV/0 ! #DIV/0! #DIV/01 #DIV/o! #DIV/0! #DIV/0! #DIV/o! #DIV/01 #DIV/0! #DIV/0! #DIV/0l #DIV/0! #DIV/0! #DIV/0! #DIV/0! Remaining positions throughout the agency Total Salaries $ 1129234 .361 $21 , 500.35 $0.001 0.00° FRINGE BENEFITS DETAIL A (Funder Specific Budget . Funder B ° Pe sion D Worker's Unemployme Total Fringes Funder Column C only, from line 22 to 27) Speck FICA TO% (A x %) Health Ins. Compens, nt Compens. Speck Position Title / Total Hrs/wk Budget Example: Case Manager / 40hrs 59000.00 382.50 200. 00 500. 00 300.00 200.00 1,582.50 Executive Director/ 40 hours 0 .00 0 . 00 0.0 Family Resource Coordinator/ 40 hours 0.00 0 .00 0. 0 Bookkeeper/ 40 hours 0.00 0.00 0.0 0 0. 00 0 .00 0.0 0 0 . 00 0.00 0 .0 0 0 . 00 0.00 0.0 0 0 . 00 0.00 0.0 0 0 . 00 0. 00 0. 0 0 0 .00 0. 00 0.0 0 0 .00 0. 00 0.0 0 0.00 0 .00 0 .0 0 0.00 0. 00 0. 0 0 0.00 0. 00 1 0.0 0 0.00 0. 00 0. 0 0 0. 00 0 .00 0.0 0 0. 00 0 . 00 0 .0 0 0. 00 0 . 00 0. 0 0 0. 00 0 . 00 0 . 0 0 0. 00 0.00 0 . 0 0 0. 00 0 .00 0.00 Total Funder Request Fringe Benefits $0. 00 $0. 00 $0.00 $ 0 . 00 $0 . 00 $0 . 00 $0.0 A B C D EXPENDITURES GRAY AREAS FOR Proposed Total Program Funder Specific Total Agency AGENCY USE ONLY TO SHOW DETAIL Budget Budget Budget 27 Travel-Daily 20 . 00 0 . 00 21500 .00 # of Staff x average # of miles/wk x 50 wks x $ = Estimated Daily Travel/Mileage Reimb . 28 Travel/conferences/Training 0 .001 0 . 001 1 ,000 . 00 5/13/2005 B'1 Community Child Care Resources, Inc. Psychological Services Children's Services Advisory Committee 3 . REPORTING : What will you do with this information to show that change has occurred? How will you use or present these results to the consumer, the funder, the program, and the community? How will you use this information to improve your program ? Services to Families- Reporting Change a. The number of referrals for service will be compared with the number of Mental Health Provider Forms completed . This will document the percent of families following through on referral . b . Data collected from the Mental Health Provider Form is used to compare the patient ' s level of functioning before and after treatment. This will document the percent of patients who raised their GAF scores. Services to Classrooms- Reporting Change a. The Teacher Pre-Observation Form serves as a baseline in determining change . b . The Psychological Services Classroom Report Form documents areas to be addressed and strategies to be implemented. Sharing Results With the Consumer: Historical data about the percentage of CCCR families using psychological services are used as a "marketing tool" to help current CCCR families become comfortable asking for help . Therapists will be involved in future family orientations to describe the type of help they can offer through CCCR. Individually, therapists can help parents and children see what they have accomplished. DECA results are interpreted for parents during conferences to better describe how the child functions in a group , and the child' s status with social/emotional development With the Funder: Results are used to show progress and measure success . Generally presented in chart form, they document that the program delivers the services for which it is being funded . With the Program : Results are used by Board and staff to validate that the mission is being carried forward . Evaluative information helps target areas for improvement and growth. With the Community: Sharing measurable results about your program leads to community awareness that in turn may lead to new sources of funding . Outcome success also results in attracting quality people to your organization. Application for 2005 -2006 service period 12 Community Child Care Resources, Inc. Psychological Services Children 's Services Advisory Committee G. TIMETABLE (Section G not to exceed one page) 1 . List the major action steps , activities, or cycles of events that will occur within the program year. New programs should include any start-up planning that may occur outside the fundingyear. In completing the timetable, review information detailed in prior sections. Month/Period Activities Psychological Support to Children and Families 1 . Ongoing 1 . Referral and authorization process 2 . Ongoing 2 , Treatment 3 . Ongoing 3 . Family Resource Coordinator monitors treatment plan with therapist and shares as appropriate with Center, 4 . December and April 4. Mental Health Provider Forms completed by therapists. 5 . January and May 5 , Mental Health Provider Forms reviewed by Program Committee 6 . At discharge 6 . Client satisfaction survey completed by parent Psychological Support to Centers 1 . Ongoing 1 . Documentation of need for clinical classroom support 2 . Prior to Visit by therapist 2 . Teacher completes classroom report prior to- , observation for psychological services provider 3 . Day of Visit 3 . Therapist completes Psychological Services Classroom Report 4 . Day of Visit 4 . Behavior Management Plan put in place 5 . Ongoing 5 . Family Resource Coordinator conducts classroom follow-up . 6 . December and May 6 . Psychological Services Classroom Report reviewed by Program Committee Application for 2005 -2006 service period 13 Type the Organization and Program Name • National Conference (cost per staff) • Training/Seminar (cost per staff) • Other Trainings (cost of travel, lodging , registration , food) 29 Office Supplies 450. 00 0.00 51500.00 • Office supplies (monthly average x 12 months = estimated cost of office supplies based on present history. 30 Telephone 650.00 0.00 31120.00 • # Phone lines x average cost per month x 12 months = local phone cost • Average long distance calls x 12 months = Estimated cost of long distance 31 Postage/Shipping 500. 00 0.00 8,000.00 • Quarterly Mailing of Newsletter • Special events , etc. Bulk mailings - appeals 32 Utilities 200. 00 0. 00 4500.00 Electricity ($ x 12 months) • Water/Sewer ($ x 12 months) • Garbage ($ x 12 months) 3 Occupancy (Building & Grounds) 11000.00 0.00 20,000.00 Mortgage/Rent ($ x 12 months) Janitorial ($ x 12 months) Grounds Maint. ($ x 12 months) Real Estate Taxes 34 Printing & Publications 500.00 0. 00 80000.00 • Quarterly Newsletter ($ x 4) • Letterheads , Envelopes , etc. • Fundraising materials Other 35 Subscription/Dues/Memberships 0.00 0.00 1 ,040 .00 • Membership to National Organization • Dues • Subscriptions to Newspapers/magazines , fInsurance t 360 .00 0. 00 6,458.00 ors/Officers Liab. ercial/General Insurance ns . nsurance 37 Equipment: Rental & Maintenance 0 . 001 0 . 00 818 . 00 • Copier lease ($ x 12 months ) • Meter lease ($ x 12 months ) • Copier Maintenance ($ x 12 months) • Computer Maintenance ( $ x 12 months) • Other 38rAdvertising 0. 00 0. 00 1 ,500. 00 paper ads aising ads/promotions (vacancies ) 39 Equipment Purchases : Capital Expense 0 . 00 0.00 0. 00 • Computer/monitor (# x $) • Laser Printer 40 Professional Fees (Legal, Consulting) 12 , 300 . 001 79000. 00 139050.00 • Legal advice ( estimated #hrs x $) • Consultant fees • Other 41 Books/Educational Materials 0 . 00 0. 00 2,600. 00 • Books/videos • Materials ($ x staff) 5/13/2005 B-1 Type the Organization and Program Name 42 Food & Nutrition 0. 00 0.00 19000.00 • Meals ( # meals x clients x 5days x 50 wks) • Snacks 43 Administrative Costs 0. 00 0.00 5,616.00 • Admin . Cost (% of total budget) 44 Audit Expense 0. 00 0 .00 7,280.00 • Independent Audit Review 45 Specific Assistance to Individuals 0. 00 0.00 3,500.00 • Medical assistance • Meals/Food • Rent Assistance • Other 46 Other/Miscellaneous 0 . 00 0.00 0. 00 • Background check/drug test • Other 47 Other/Contract 0 .00 0.00 417,237.00 Sub-contract for program services 48 TOTAL EXPENSES $39 ,015. 13 $7,000.00 $634,611 .36 5/13/2005 B-1 o4i W (7*, CIA PC tI 1 1 I I 1 1 o . It fit � L C I I 1 I I I I I I 1 CIN �[ \ Nta I 1 1 N 1 1 1 N W y Jill" I MY 00 00 00 a3 6l 2P'd 5�6Y" Ov t� 00 N 1 I 1 1 I I d 01 CN O ONO a aU *6 o N i . /PC T M." @g�'�� Wool N o 13 y ��1 b9lU ? }hTT _ q pa U o U _ a `�' as U •� ,-a° ,� 1 C�o I r��n • `" r � , � � oIn -4 kr) °, o Type the Organization and Program Name Example: Executive Director/ 40hrs 70, 000.00 101000.00 5,000.00 7. 14% Executive Director/ 40 hours 46, 800. 00 99360. 00 0.00° Family Resource Coordinator/ 40 hours 37,312 . 76 9,328. 19 p,pp° Bookkeeper/ 40 hours 28 , 121 .60 21812. 16 0.00% #DIV/0! #DIV/0! #DIV/0! #DIV/0 ! #DIV/0 ! #DIV/0! #DIV/0! #DIV/0! #DIV/0 ! #DIV/0! #DIV/0 ! #DIV/0 ! #DIV/0! #DIV/0! #DIV/0! #DIV/0! Remaining positions throughout the agency #DIV/01 Total Salaries $ 112,234 .361 $21 , 500 . 35 $0.001 0.00% FRINGE BENEFITS DETAIL A (Funder Specific Budget . Funder B c D E F G S cific FICA 7.65% Pension Worker's Unemph>yme Total Fringes Funder Column C only, from line 22 to 27) p (A x %) Health Ins. Compens, nt Compens. Specific Position Title / Total Hrs/wk Budget Example: Case Manager / 4ohrs 51000. 00 382. 50 200. 00 500.00 300. 00 200. 00 11582.50 Executive Director/ 40 hours 0 . 00 0.00 0. 0 Family Resource Coordinator/ 40 hours 0 . 00 0.00 0. 0 Bookkeeper/ 40 hours 0 . 00 0.00 0. 0 0 0 . 00 0.00 0. 0 0 0. 001 0.00 0. 0 0 0. 001 0. 00 0. 0 0 0.00 0 . 00 0.00 0 0 .00 0 . 00 0.0 0 0.00 0 . 00 0. 0 0 0 . 00 0. 00 0 .0 0 0. 00 0. 001 0.0 0 - --0.001 0. 001111 0 .0 0 0 . 001 0. 00 0.0 0 0 . 001 0. 00 0.0 0 0. 001 0. 00 0.0 0 0 . 001 0. 00 1 0. 0 0 0. 001 0. 00 0. 001 0 0. 001 0 .00 0. 0 0 0. 00 0 . 00 0. 001 0 0. 001 0 . 00 0. 001 Total Funder Request Fringe Benefits $ . 001 $0 . 00 $0. 00 $0 . 00 $0 . 00 $0 . 00 $0 . 0 A B C D EXPENDITURES GRAY AREAS FOR Proposed Total Program Funder Specific Total Agency AGENCY USE ONLY TO SHOW DETAIL Budget Budget Budget 27 Travel-Daily 20 . 00 0 . 00 21500. 00 # of Staff x average # of miles/wk x 50 wks x $ = Estimated Daily Travel/Mileage Reimb . 28 Travel/Conferences/Training 0 . 001 0 . 00 11000 . 00 5/13/2005 B-1 Type me Oryarm°m and Pmr= Noma UNIFORM GRANT APPLICATION TOTAL AGENCY BUDGET AGENCY/PROGRAM NAME : Community Child Care Resources, Inc. FY 03/04 FY 04105 FY 05/06 % INCREASE CURRENT VS. July 1 - June 30 July 1 - June 30 July 7 - June 30 NEXT FY BUDGET A B C D ACTUAL TOTAL PROPOSED (col. C-col. Bycol. B . REVENUES BUDGETED BUDGETED 1 Children's Services Council-St Lucie 0.00 #DIV/01 2 Children's Services Council-Martin 0.00 #DIV/01 3 Advisory Committee-Indian River 186 350.00 207 000.00 207 000.00 0.00% 4 United Way-St Lucie County 0.00 #DIV/01 5 United Way-Martin County 0.00 #DIV/01 6 United Way- Indian River 177 766.00 183y954.00 191 152.00 3.91 % 7 Department of Children & Families 0.00 #DIV/01 8 County Funds 0.00 #DIV/01 9 Contributions-Cash 120 818.00 108 500.00 130r000,00 19.82% 10 Pro ram Fees 65j315.001 56 000.00 62 000.00 10.71 % 11 Fund Raising Events-Net 18 093.00 20 000.00 30 000.00 50.00% 12 Sales to Public-Net 0.00 #DIV/01 13 Membership Dues 0.00 #DIV/01 14 Investment Income 686.00 0.00 0.00 #DIV/01 15 Miscellaneous 0.00 #DIV/01 16 Le acies & Bequests 0.00 #DIV/01 17 Funds from Other So =total) 16,505,00 29.00 12 000.00 1200000 0.00% 18 Reserve Funds Used fOperating 00.00 3999900 5000.00 -87.50% 19 In-Kind Donations (Not05.00 500000 5 000.00 0.00% 20 TOTAL2.00 62745300 637 152.00 1 .55% EXPEN 21 Salaries 98 689.02 113P432133' 13 432.33 112 234.36 -1 .06°k 22 FICA 7o649.711 89677,57 89594.001 -0.96% 23 Retirement 0.00 #DIV/01 24 Life/Health 0.00 #DIV/01 25 Workers Compensation 991 .001 11023.00 1 j064.00 4.01 % 26 Florida Unemployment 0.00 #DIV/01 27 Travel-Daily 11086.00 200000 2 500.00 25.00% 28 Travel/Conferences/Training 980.001 000.00 1 000.00 0.00% 29 Office Supplies 51464,00 62000.00 52500.00 -8.33% 30 Telephone 2 992.00 31000,00 39120.00 4.00% 31 Postaae/Shipping 2155.00 550000 8 000.00 45.45% 32 Utilities 29415.00 270000 40500.00 66.67% 33 Occupancy (Building & Grounds 19;370.00 57 907.00 20 000.00 -65.46% 34 Printing & Publications 2p245,00 550000 8000z===00 45.45% 35 Subscription/Dues/Memberships 886.00 19000.00 19040.00 4.00% 36 Insurance 51630.00 615100 6458.00 4.99% 37 Eg ui ment: Rental & Maintenance 742.00 779.00 818.00 5.01 % 38 Advertising 17045.00 120000 19500.00 25.00% 39 Equipment Purchases :Ca ital Expense 0.00 11500,00 0.00 -100.000/. 40 Professional Fees (Legal, Consulting) 11 330.00 12 050.00 13 050.00 8.30% 41 Books/Educational Materials 2 000.00 21400.00 2$600.001 8.33% 42 Food & Nutrition 675.00 720.00 11000.00 38.890 43 Administrative Costs 49500.00 52500.00 51616.00 2. 11 % 44 Audit Expense 61400,00 700000 71280.00 4.00% 45 Specific Assistance to Individuals 21000.00 31450.00 39500.00 1 .45% 46 Other/Miscellaneous 0.00 0.00 0.00 #DIV/01 47 Other/Contract 361 312.00395 628.00 417 237.00 5.46% 48 TOTAL 540 456.73 644117.90 634 611 .36 -1 .48% 49 REVENUES OVER/ UNDER EXPENDITURES 67 305 .27 -16,664.90 29540. 64 -115.25% 5113r2WS 0.2 Tpe aw Orgwv=Wn wW Ploq n NL UNIFORM GRANT APPLICATION TOTAL PROGRAM BUDGET AGENCY/PROGRAM NAME :Community Chlld Care Resources, Inc./Psycho ical Services FY 03104 FY 04/05 FY 05/06 % INCREASE FYE July-June FYE July-June FYE July-June CURRENT VS. NEXT FY BUDGET A B C D ACTUAL TOTAL PROPOSED (col. C-col. Bycol. 6 REVENUES BUDGETED BUDGETED 1 Children's Services Council-St. Lucie 0.00 #DIV/Ol 2 Children's Services Council-Martin 0.00 #DIV/01 3 Advisory Committee-Indian River 61350,00 700000 7000,00 0.00% 4 United Way-St Lucie County 0.00 #D-IV/01 5 United Way-Martin County 0.00 #DIV/01 6 United Way - Indian River County 4,000,00 400000 4000,00 0.00% 7 Department of Children & Families 0.00 #DIV/O! 8 County Funds 0.00 #DIV/01 9 Contributions-Cash 17 500.00 19 000.00 16 502.00 -13. 15% 10 Pro ram Fees 5 000.00 600000 7 022.00 17.03% 11 Fund Raising Events-Net 59000.00 469800 59000,00 6.43% 12 Sales to Public-Net 0.00 #DIV/Ol 13 Membership Dues 0.00 #DIV/01 14 Investment Income 0.00 #DIV/01 15 Miscellaneous 0.00 #DIV/Ol 16 Leglacies & Bequests 0.00 #DIV/OI 17 Funds from Other Sources 0.00 #DIV/01 18 Reserve Funds Used for Operating 0.00 #DIV/Ol 19 In-Kind Donations (Not included in Well 0.00 #DIV/Ol 20 TOTAL 37 850.00 40 698.00 39 524.00 -2.88% EXPENDITURES 21 Salaries 19 738.00 22 686.00 21 y500.35 -5.23% 22 FICA 11600,00 1 736.00 11644.78 -5.25% 23 Retirement 0.00 #DIV/01 24 Life/Health 0.00 #DIV/01 25 Workers Compensation 0.00 0.00 250.00 #DIV/01 26 Florida Unemployment 0.00 #DIV/0I 27 Travel-Daily 16.00 20.00 20.00 0.00% 28 Travel/Conferences/Training 0.00 #VALUEI 29 Office Supplies 1 200.00 11000,00 450.00 -55.00% 30 Telephone 1 t000.00 11000,00 650.00 -35.00% 31 Postage/Shipping 19000.00 500.00 500.00 0.00% 32 Utilities 950.00 500.00 200.00 -60.00% 33 Occupancy (Building & Grounds 1 t800.00 1 500.00 1000.00 -33.33% 34 Printing & Publications 0.00 476.00 500.00 5.04% 35 Subscription/Dues/Memberships 0.00 #DIV/01 36 Insurance 0.00 #DIV/01 37 E ui ment: Rental & Maintenance 0.00 #DIV/01 38 Advertising 0.00 #DIV/01 39 Equipment Purchases:Ca ital Expense 0.00 #DIV/01 40 Professional Fees (Legal, Consulting) 10 546.00 11 280.00 12 300.00 9.04% 41 Books/Educational Materials 0.00 #DIV/01 42 Food & Nutrition 0.00 #DIV/01 43 Administrative Costs 0.00 #DIV/01 44 Audit Expense 0.00 #DIV/0! 45 Specific Assistance to Individuals 0.00 #DIV/Ol 46 Other/Miscellaneous 0.00 #DIV/Ol 47 Other/Contract 0.00 #DIV/O! 48 TOTAL 37,860,001 40,698.001 39 015. 13 -4. 14% 49 REVENUES OVER/ UNDER EXPENDITURES 0.001 0.001 508.87 #DIV/01 51132005 eJ Type the Organization and Program Name UNIFORM GRANT APPLICATION BUDGET NARRATIVE WORKSHEET IMPORTANT: The Budget Narrative should provide details to justify the amount requested in each line item of the budget for your program. From this worksheet, your figures will be linked to the Total Agency Budget, Total Program Budget and Funder Speck Budget Forms. AGENCY/PROGRAM NAME : Community Child Care Resources , Inc ./Psychological Services FUNDER : Advisory Committee-Indian River PAUTION : Do not enter any figures where a cell is colored in dark blue - Formulas and/or links are in place. Gray areas should j be a used for calculations and to write information only. ; GRAY AREAS FOR �77 NUMENEW'WE I REVENUES AGENCY USE ONLY Proposed Total Program Funder Specific Total Agency VJHO ' �) Budget Budget Budget 1 Children's Services Council-St Lucie 2 Children's Services Council-Martin 3 Advisory Committee-Indian River 79000.00 7,000 .00 207,000.00 4 United Way-St Lucie County 5 United Way-Martin County 6 United Way-Indian River County 4, 000.00 1919152 . 00 7 Department of Children & Families 8 County Funds CC, Found , 9 Contributions-Cash Churches , Org 16, 502 . 00 130,000.00 10 Program Fees Parent fee 7rO22.001 629000 . 00 11 Fund Raising Events-Net 5 ,000 . 00 300000.00 12 Sales to Public - Net 13 Membership Dues 14 Investment Income 15 Miscellaneous 16 Legacies & Bequests 17 Funds from Other Sources ALPI 12, 000. 00 18 Reserve Funds Used for Operating Shajara Found 5, 000.00 19 In-Kind Donations (Not Included in total) 51000.00 20 TOTAL REVENUES (doesn't include line 19) $39, 524 .00 $7,000.00 $6370152. 00 A B C D EXPENDITURES GRAY AREAS FOR Proposed Total Program Funder Specific Total Agency AGENCY USE ONLY (SHOW CALCULATIONS) Budget Budget Budget 21 Salaries - (must complete chart on next page) 21 , 500. 35 0. 00 112 ,234. 36 MFILUF 70 -- Salary 22 FICA - Total salaries x 0. 0765 7.65% 11644 . 78 0 . 00 81594 . 00 e firemen - Annual pensionor qua i )e 23 staff 0. 00 Life/H;alth - Medical/Dental/Short-term 24 Disab . 0.00 Workers Compensation - # employees x 25 rate 250 . 00 0. 00 1 ,064 . 00 ori a Unemployment - # projected 26 employees x $7 , 000 x UCT-6 rate 0 . 00 SALARIES A B D C % of Gross Annual POSITION LISTING Gross Annual Portion of salary on Proposed Salary Program Funder Specific Budget Salary Position Title / Total HrsAvk (Agency) Requested(CIA) 5/13/2005 B-1 Type the Organization and Program Name UNIFORM GRANT APPLICATION FUNDER SPECIFIC BUDGET PROGRAM EXPENSES AGENCY/PROGRAM NAME : Community Child Care Resources , Inc./Psychological Services FUNDER : Advisory Committee-IR 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 21 , 500 .35 0 .00 0. 00% 22 FICA 1 ,644. 78 0. 00 0 .00% 23 Retirement 0 . 00 0 .00 #DIV/01 24 Life/Health 0.00 0. 00 #DIV/01 25 Workers Compensation 250 . 00 04001 0 .00% 26 Florida Unemployment 0 .00 0 .00 #DIV/01 27 Travel =Daily 20.00 0.00 0 .00% 28 Travel/Conferences/Training 0 .00 0 .00 #DIV/01 29 Office Supplies 450 .00 0 .00 0.00% 3o Telephone 650.00 0.00 0 . 00% 31 Postage/Shipping 500 .00 0. 00 0 . 00% 32 Utilities 200 .00 0 .00 0 . 00% 33 Occupancy (Building & Grounds 10000 . 00 0 . 00 0 . 00% 34 Printing & Publications 500 .00 0 .00 0. 00% 35 Subscription/Dues/Memberships 0 . 00 0 . 00 #DIV/01 36 Insurance 0.00 0 .00 #DIV/0 ! 37 E ui ment: Rental & Maintenance 0 . 00 0 .00 #DIV/01 38 Advertising 0 . 00 0. 00 #DIV/01 39 Equipment Purchases : Capita I Expense 0 . 00 0 .00 #DIV/01 40 Professional Fees (Legal , Consulting) 12, 300 . 0079000 . 00 56 . 91 % 41 Books/Educational Materials 0 . 00 0 . 00 #DIV/01 42 Food & Nutrition 0 . 00 0 . 00 #DIV/01 43 Administrative Costs 0 . 00 0 . 00 #DIV/0 ! 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 0 .00 #DIV/01 48 TOTAL 1 $399015. 13 $7 , 000 . 00 17. 9407/0 5/13/2005 B3 Type the Orper&wtion and Program Name UNIFORM GRANT APPLICATION EXPLANATION FOR VARIANCES OF 15% OR MORE TOTAL PROGRAM BUDGET AGENCY/PROGRAM NAME: Community Child Care Resources, IncJPsychological Services FUNDER: Advisory Committee-IR Ali #D ! MDIWVIOI *01 a#D #DIVI01 N/O!#DvO!= 7 -- - Program Fees Hurricanes had stmng impact on parente abilities to pa #DIVIO! #DNI01 #DIVIO! #DMO! #DMO! #DIVIO! #DNIO! #DIVIO! #DIVro! #DIVIOI #DIVI01 #DMO! #VALUE! #DIV/0! #DIV101 #DIVIO! #DIV/01 #DN/01 #DIVIO! #DIV/01 #DIV/0! #DIVI01 #DIVl01 #DIV/0I #DN101 51132005 BS Type the Organization and Program Name Example: Executive Director/ 40 hrs 70,000.00 10,000.00 51000.00 7.14% Executive Director/ 40 hours 46, 800.00 99360.00 0.00° Family Resource Coordinator/ 40 hours 37,312 .76 9,328. 19 0.00° Bookkeeper/ 40 hours 281121 .60 2,812. 16 0.00° #DIV/O! #DIV/0! #DIV/0 ! #DIV/0! #DIV/01 #DIV/o! #DIV/0! #DIV/0! #DIV/o! #DIV/01 #DIV/0! #DIV/0! #DIV/0l #DIV/0! #DIV/0! #DIV/0! #DIV/0! Remaining positions throughout the agency Total Salaries $ 1129234 .361 $21 , 500.35 $0.001 0.00° FRINGE BENEFITS DETAIL A (Funder Specific Budget . Funder B ° Pe sion D Worker's Unemployme Total Fringes Funder Column C only, from line 22 to 27) Speck FICA TO% (A x %) Health Ins. Compens, nt Compens. Speck Position Title / Total Hrs/wk Budget Example: Case Manager / 40hrs 59000.00 382.50 200. 00 500. 00 300.00 200.00 1,582.50 Executive Director/ 40 hours 0 .00 0 . 00 0.0 Family Resource Coordinator/ 40 hours 0.00 0 .00 0. 0 Bookkeeper/ 40 hours 0.00 0.00 0.0 0 0. 00 0 .00 0.0 0 0 . 00 0.00 0 .0 0 0 . 00 0.00 0.0 0 0 . 00 0.00 0.0 0 0 . 00 0. 00 0. 0 0 0 .00 0. 00 0.0 0 0 .00 0. 00 0.0 0 0.00 0 .00 0 .0 0 0.00 0. 00 0. 0 0 0.00 0. 00 1 0.0 0 0.00 0. 00 0. 0 0 0. 00 0 .00 0.0 0 0. 00 0 . 00 0 .0 0 0. 00 0 . 00 0. 0 0 0. 00 0 . 00 0 . 0 0 0. 00 0.00 0 . 0 0 0. 00 0 .00 0.00 Total Funder Request Fringe Benefits $0. 00 $0. 00 $0.00 $ 0 . 00 $0 . 00 $0 . 00 $0.0 A B C D EXPENDITURES GRAY AREAS FOR Proposed Total Program Funder Specific Total Agency AGENCY USE ONLY TO SHOW DETAIL Budget Budget Budget 27 Travel-Daily 20 . 00 0 . 00 21500 .00 # of Staff x average # of miles/wk x 50 wks x $ = Estimated Daily Travel/Mileage Reimb . 28 Travel/conferences/Training 0 .001 0 . 001 1 ,000 . 00 5/13/2005 B'1 Type the Organization and Program Name • National Conference (cost per staff) • Training/Seminar (cost per staff) • Other Trainings (cost of travel, lodging , registration , food) 29 Office Supplies 450. 00 0.00 51500.00 • Office supplies (monthly average x 12 months = estimated cost of office supplies based on present history. 30 Telephone 650.00 0.00 31120.00 • # Phone lines x average cost per month x 12 months = local phone cost • Average long distance calls x 12 months = Estimated cost of long distance 31 Postage/Shipping 500. 00 0.00 8,000.00 • Quarterly Mailing of Newsletter • Special events , etc. Bulk mailings - appeals 32 Utilities 200. 00 0. 00 4500.00 Electricity ($ x 12 months) • Water/Sewer ($ x 12 months) • Garbage ($ x 12 months) 3 Occupancy (Building & Grounds) 11000.00 0.00 20,000.00 Mortgage/Rent ($ x 12 months) Janitorial ($ x 12 months) Grounds Maint. ($ x 12 months) Real Estate Taxes 34 Printing & Publications 500.00 0. 00 80000.00 • Quarterly Newsletter ($ x 4) • Letterheads , Envelopes , etc. • Fundraising materials Other 35 Subscription/Dues/Memberships 0.00 0.00 1 ,040 .00 • Membership to National Organization • Dues • Subscriptions to Newspapers/magazines , fInsurance t 360 .00 0. 00 6,458.00 ors/Officers Liab. ercial/General Insurance ns . nsurance 37 Equipment: Rental & Maintenance 0 . 001 0 . 00 818 . 00 • Copier lease ($ x 12 months ) • Meter lease ($ x 12 months ) • Copier Maintenance ($ x 12 months) • Computer Maintenance ( $ x 12 months) • Other 38rAdvertising 0. 00 0. 00 1 ,500. 00 paper ads aising ads/promotions (vacancies ) 39 Equipment Purchases : Capital Expense 0 . 00 0.00 0. 00 • Computer/monitor (# x $) • Laser Printer 40 Professional Fees (Legal, Consulting) 12 , 300 . 001 79000. 00 139050.00 • Legal advice ( estimated #hrs x $) • Consultant fees • Other 41 Books/Educational Materials 0 . 00 0. 00 2,600. 00 • Books/videos • Materials ($ x staff) 5/13/2005 B-1 Type the Organ®6on end Program Name UNIFORM GRANT APPLICATION EXPLANATION FOR VARIANCES OF 15% OR MORE FUNDER SPECIFIC BUDGET AGENCY/PROGRAM NAME: Community Child Care Resources, IncJPsychological Services FUNDER: Advisory Committee-IR .,.. ,..... . ,- <.8 •: tea' ., . , , �e�i . .. x •. � f . , ., .. . . : 3., tr .. . N'b .�% ��� „�.,,�,f� M MEW 7 #DNI01 #DN/01 "#MDIV/01 #DN/01 Total program and funder spec budget includes United Way portion for psychological services of $4,000. No increases requested. M a Fees Le al Consultin Funding request of $7,000 same as 2004-2005 request. #DN/01 #DIV/OS 5/132005 BS Community Child Care Resources, Inc. Psychological Services Children's Services Advisory Committee ORGANIZATION : Community Child Care Resources, Inc. PROGRAM : _ Psychological Services TABLE OF CONTENTS 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 Page # X TABLE OF CONTENTS (check list) 1 X COVER PAGE (with signatures) . 116 * 0 0 . . . . 3 A. ORGANIZATION CAPABILITY (one page maximum) X 1 . Mission and Vision of organization . . 1 0 1 0 1 a I a 0 4 * 1 6 0 0 00 0 4 0 0 0 0 4 9 . . . . . . . . . . . . . . . . . . . . . . . 4 2. Summary of expertise, accomplishments, and population served . . 4 B. PROGRAM NEED STATEMENT (one page maximum) X 1 . Program Need Statement . . . . . . , . . . . " , ' , * * @ 5 X 2 . Programs that address need and gaps in service . . . , . . . , . . 5 C. PROGRAM DESCRIPTION (two pages maximum) X 1 . Funding priority . . . 1 1 . 1 0 1 1 1 1 1 1 1 1 1 " 0 . . . . . * 0 0 , " 0 9 a * 0 0 0 . . a a . . . . . . * . . . . . . . . . . . X 2 . Description of program activities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . " 1 X 3 . Evidence that program strategy will work . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 X4 . Staffing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 X 5 . Awareness of program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 X 6 . Accessibility of program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 . . . . 0 6 0 . . . . . . . . . . . . . . . . . . 7 X D. MEASURABLE OUTCOMES (two pages maximum) . . . . . . . . . . . . . . . . . . . 011111 8 X E . COLLABORATION (one page maximum) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 F. PROGRAM EVALUATION (two pages maximum) X 1 . Demographics . . . 11 * 11 , 601 , 110 , " 1 , $ 11 X 2 . Measures . . . . . 4 , 0 * 0 , q " * , 0 . . . . . . . . . $ " 0 " " 11 X3 . Reporting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 . . . . . . . . . . . " 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 Application for 2005 -2006 service period 1 Type the Organization and Program Name 42 Food & Nutrition 0. 00 0.00 19000.00 • Meals ( # meals x clients x 5days x 50 wks) • Snacks 43 Administrative Costs 0. 00 0.00 5,616.00 • Admin . Cost (% of total budget) 44 Audit Expense 0. 00 0 .00 7,280.00 • Independent Audit Review 45 Specific Assistance to Individuals 0. 00 0.00 3,500.00 • Medical assistance • Meals/Food • Rent Assistance • Other 46 Other/Miscellaneous 0 . 00 0.00 0. 00 • Background check/drug test • Other 47 Other/Contract 0 .00 0.00 417,237.00 Sub-contract for program services 48 TOTAL EXPENSES $39 ,015. 13 $7,000.00 $634,611 .36 5/13/2005 B-1 Type me Oryarm°m and Pmr= Noma UNIFORM GRANT APPLICATION TOTAL AGENCY BUDGET AGENCY/PROGRAM NAME : Community Child Care Resources, Inc. FY 03/04 FY 04105 FY 05/06 % INCREASE CURRENT VS. July 1 - June 30 July 1 - June 30 July 7 - June 30 NEXT FY BUDGET A B C D ACTUAL TOTAL PROPOSED (col. C-col. Bycol. B . REVENUES BUDGETED BUDGETED 1 Children's Services Council-St Lucie 0.00 #DIV/01 2 Children's Services Council-Martin 0.00 #DIV/01 3 Advisory Committee-Indian River 186 350.00 207 000.00 207 000.00 0.00% 4 United Way-St Lucie County 0.00 #DIV/01 5 United Way-Martin County 0.00 #DIV/01 6 United Way- Indian River 177 766.00 183y954.00 191 152.00 3.91 % 7 Department of Children & Families 0.00 #DIV/01 8 County Funds 0.00 #DIV/01 9 Contributions-Cash 120 818.00 108 500.00 130r000,00 19.82% 10 Pro ram Fees 65j315.001 56 000.00 62 000.00 10.71 % 11 Fund Raising Events-Net 18 093.00 20 000.00 30 000.00 50.00% 12 Sales to Public-Net 0.00 #DIV/01 13 Membership Dues 0.00 #DIV/01 14 Investment Income 686.00 0.00 0.00 #DIV/01 15 Miscellaneous 0.00 #DIV/01 16 Le acies & Bequests 0.00 #DIV/01 17 Funds from Other So =total) 16,505,00 29.00 12 000.00 1200000 0.00% 18 Reserve Funds Used fOperating 00.00 3999900 5000.00 -87.50% 19 In-Kind Donations (Not05.00 500000 5 000.00 0.00% 20 TOTAL2.00 62745300 637 152.00 1 .55% EXPEN 21 Salaries 98 689.02 113P432133' 13 432.33 112 234.36 -1 .06°k 22 FICA 7o649.711 89677,57 89594.001 -0.96% 23 Retirement 0.00 #DIV/01 24 Life/Health 0.00 #DIV/01 25 Workers Compensation 991 .001 11023.00 1 j064.00 4.01 % 26 Florida Unemployment 0.00 #DIV/01 27 Travel-Daily 11086.00 200000 2 500.00 25.00% 28 Travel/Conferences/Training 980.001 000.00 1 000.00 0.00% 29 Office Supplies 51464,00 62000.00 52500.00 -8.33% 30 Telephone 2 992.00 31000,00 39120.00 4.00% 31 Postaae/Shipping 2155.00 550000 8 000.00 45.45% 32 Utilities 29415.00 270000 40500.00 66.67% 33 Occupancy (Building & Grounds 19;370.00 57 907.00 20 000.00 -65.46% 34 Printing & Publications 2p245,00 550000 8000z===00 45.45% 35 Subscription/Dues/Memberships 886.00 19000.00 19040.00 4.00% 36 Insurance 51630.00 615100 6458.00 4.99% 37 Eg ui ment: Rental & Maintenance 742.00 779.00 818.00 5.01 % 38 Advertising 17045.00 120000 19500.00 25.00% 39 Equipment Purchases :Ca ital Expense 0.00 11500,00 0.00 -100.000/. 40 Professional Fees (Legal, Consulting) 11 330.00 12 050.00 13 050.00 8.30% 41 Books/Educational Materials 2 000.00 21400.00 2$600.001 8.33% 42 Food & Nutrition 675.00 720.00 11000.00 38.890 43 Administrative Costs 49500.00 52500.00 51616.00 2. 11 % 44 Audit Expense 61400,00 700000 71280.00 4.00% 45 Specific Assistance to Individuals 21000.00 31450.00 39500.00 1 .45% 46 Other/Miscellaneous 0.00 0.00 0.00 #DIV/01 47 Other/Contract 361 312.00395 628.00 417 237.00 5.46% 48 TOTAL 540 456.73 644117.90 634 611 .36 -1 .48% 49 REVENUES OVER/ UNDER EXPENDITURES 67 305 .27 -16,664.90 29540. 64 -115.25% 5113r2WS 0.2 Community Child Care Resources, Inc. Psychological Services Children 's Services Advisory Committee X 1 . Financial Budget Forms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 J. FUNDER SPECIFIC/ADDITIONAL SHEETS K. APPENDIX Application for 2005 -2006 service period 2 SUPPORTING DOCUMENTS CHECKLIST RFP 7052 /Cover Page �- Application X- a List of current officers and directors Latest Financial Audit Report & Management Letter that conforms with the AICPA Audit Guide Most recent IRS Form 990, including all schedules Most recent Internal Financial Statement (i . e . : Balance Sheet and Operating Budget Staff Organizational Chart Most Recent Annual Report (if available) 501 (C)(3 ) IRS Exemption Letter Articles of Incorporation ✓ Agency ' s Bylaws Not For Profit Agency Certification Agency' s written policy regarding Affirmative Action ✓ Nepotism Statement Transportation Letter Insurance Certificates Authorization Release of Information x 3 `/ Testing Forms Tpe aw Orgwv=Wn wW Ploq n NL UNIFORM GRANT APPLICATION TOTAL PROGRAM BUDGET AGENCY/PROGRAM NAME :Community Chlld Care Resources, Inc./Psycho ical Services FY 03104 FY 04/05 FY 05/06 % INCREASE FYE July-June FYE July-June FYE July-June CURRENT VS. NEXT FY BUDGET A B C D ACTUAL TOTAL PROPOSED (col. C-col. Bycol. 6 REVENUES BUDGETED BUDGETED 1 Children's Services Council-St. Lucie 0.00 #DIV/Ol 2 Children's Services Council-Martin 0.00 #DIV/01 3 Advisory Committee-Indian River 61350,00 700000 7000,00 0.00% 4 United Way-St Lucie County 0.00 #D-IV/01 5 United Way-Martin County 0.00 #DIV/01 6 United Way - Indian River County 4,000,00 400000 4000,00 0.00% 7 Department of Children & Families 0.00 #DIV/O! 8 County Funds 0.00 #DIV/01 9 Contributions-Cash 17 500.00 19 000.00 16 502.00 -13. 15% 10 Pro ram Fees 5 000.00 600000 7 022.00 17.03% 11 Fund Raising Events-Net 59000.00 469800 59000,00 6.43% 12 Sales to Public-Net 0.00 #DIV/Ol 13 Membership Dues 0.00 #DIV/01 14 Investment Income 0.00 #DIV/01 15 Miscellaneous 0.00 #DIV/Ol 16 Leglacies & Bequests 0.00 #DIV/OI 17 Funds from Other Sources 0.00 #DIV/01 18 Reserve Funds Used for Operating 0.00 #DIV/Ol 19 In-Kind Donations (Not included in Well 0.00 #DIV/Ol 20 TOTAL 37 850.00 40 698.00 39 524.00 -2.88% EXPENDITURES 21 Salaries 19 738.00 22 686.00 21 y500.35 -5.23% 22 FICA 11600,00 1 736.00 11644.78 -5.25% 23 Retirement 0.00 #DIV/01 24 Life/Health 0.00 #DIV/01 25 Workers Compensation 0.00 0.00 250.00 #DIV/01 26 Florida Unemployment 0.00 #DIV/0I 27 Travel-Daily 16.00 20.00 20.00 0.00% 28 Travel/Conferences/Training 0.00 #VALUEI 29 Office Supplies 1 200.00 11000,00 450.00 -55.00% 30 Telephone 1 t000.00 11000,00 650.00 -35.00% 31 Postage/Shipping 19000.00 500.00 500.00 0.00% 32 Utilities 950.00 500.00 200.00 -60.00% 33 Occupancy (Building & Grounds 1 t800.00 1 500.00 1000.00 -33.33% 34 Printing & Publications 0.00 476.00 500.00 5.04% 35 Subscription/Dues/Memberships 0.00 #DIV/01 36 Insurance 0.00 #DIV/01 37 E ui ment: Rental & Maintenance 0.00 #DIV/01 38 Advertising 0.00 #DIV/01 39 Equipment Purchases:Ca ital Expense 0.00 #DIV/01 40 Professional Fees (Legal, Consulting) 10 546.00 11 280.00 12 300.00 9.04% 41 Books/Educational Materials 0.00 #DIV/01 42 Food & Nutrition 0.00 #DIV/01 43 Administrative Costs 0.00 #DIV/01 44 Audit Expense 0.00 #DIV/0! 45 Specific Assistance to Individuals 0.00 #DIV/Ol 46 Other/Miscellaneous 0.00 #DIV/Ol 47 Other/Contract 0.00 #DIV/O! 48 TOTAL 37,860,001 40,698.001 39 015. 13 -4. 14% 49 REVENUES OVER/ UNDER EXPENDITURES 0.001 0.001 508.87 #DIV/01 51132005 eJ Type the Organization and Program Name UNIFORM GRANT APPLICATION FUNDER SPECIFIC BUDGET PROGRAM EXPENSES AGENCY/PROGRAM NAME : Community Child Care Resources , Inc./Psychological Services FUNDER : Advisory Committee-IR 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 21 , 500 .35 0 .00 0. 00% 22 FICA 1 ,644. 78 0. 00 0 .00% 23 Retirement 0 . 00 0 .00 #DIV/01 24 Life/Health 0.00 0. 00 #DIV/01 25 Workers Compensation 250 . 00 04001 0 .00% 26 Florida Unemployment 0 .00 0 .00 #DIV/01 27 Travel =Daily 20.00 0.00 0 .00% 28 Travel/Conferences/Training 0 .00 0 .00 #DIV/01 29 Office Supplies 450 .00 0 .00 0.00% 3o Telephone 650.00 0.00 0 . 00% 31 Postage/Shipping 500 .00 0. 00 0 . 00% 32 Utilities 200 .00 0 .00 0 . 00% 33 Occupancy (Building & Grounds 10000 . 00 0 . 00 0 . 00% 34 Printing & Publications 500 .00 0 .00 0. 00% 35 Subscription/Dues/Memberships 0 . 00 0 . 00 #DIV/01 36 Insurance 0.00 0 .00 #DIV/0 ! 37 E ui ment: Rental & Maintenance 0 . 00 0 .00 #DIV/01 38 Advertising 0 . 00 0. 00 #DIV/01 39 Equipment Purchases : Capita I Expense 0 . 00 0 .00 #DIV/01 40 Professional Fees (Legal , Consulting) 12, 300 . 0079000 . 00 56 . 91 % 41 Books/Educational Materials 0 . 00 0 . 00 #DIV/01 42 Food & Nutrition 0 . 00 0 . 00 #DIV/01 43 Administrative Costs 0 . 00 0 . 00 #DIV/0 ! 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 0 .00 #DIV/01 48 TOTAL 1 $399015. 13 $7 , 000 . 00 17. 9407/0 5/13/2005 B3 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 184025 1h Street Vero Beach , Florida 32960-3365 Recipient : Childcare Resources of Indian River, Inc . 1801 24th Street Vero Beach , Florida 32960 Attention : Pam King , Executive Director 2 , Venue : Choice of Law. The validity, interpretation , construction , and effect of this Contract shall be in accordance with and governed by the laws of the State of Florida only. The location for settlement of any and all claims , controversies , or disputes , arising out of or relating to any part of this Contract, or any breach hereof, as well as any litigation between the parties , shall be Indian River county, Florida for claims brought in state court, and the Southern District of Florida for those claims justifiable in federal court. 3 . Entirety of Agreement. This Contract incorporates and includes all prior and contemporaneous negotiations , correspondence , conversations , agreements , and understandings applicable to the matters contained herein and the parties agree that there are no commitments , agreements , or understandings concerning the subject matter of this Contract that are not contained herein . Accordingly, it is agreed that no deviation from the terms hereof shall be predicated upon any prior representations or agreements , whether oral or written . It is further agreed that no modification , amendment or alteration in the terms and conditions contained herein shall be effective unless contained in a written document signed by both parties . 4 . Severability. In the event any provision of this Contract is determined to be unenforceable or invalid , such unenforceability or invalidity shall not affect the remaining provisions of this Contract, and every other 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 - Type the Orper&wtion and Program Name UNIFORM GRANT APPLICATION EXPLANATION FOR VARIANCES OF 15% OR MORE TOTAL PROGRAM BUDGET AGENCY/PROGRAM NAME: Community Child Care Resources, IncJPsychological Services FUNDER: Advisory Committee-IR Ali #D ! MDIWVIOI *01 a#D #DIVI01 N/O!#DvO!= 7 -- - Program Fees Hurricanes had stmng impact on parente abilities to pa #DIVIO! #DNI01 #DIVIO! #DMO! #DMO! #DIVIO! #DNIO! #DIVIO! #DIVro! #DIVIOI #DIVI01 #DMO! #VALUE! #DIV/0! #DIV101 #DIVIO! #DIV/01 #DN/01 #DIVIO! #DIV/01 #DIV/0! #DIVI01 #DIVl01 #DIV/0I #DN101 51132005 BS Type the Organ®6on end Program Name UNIFORM GRANT APPLICATION EXPLANATION FOR VARIANCES OF 15% OR MORE FUNDER SPECIFIC BUDGET AGENCY/PROGRAM NAME: Community Child Care Resources, IncJPsychological Services FUNDER: Advisory Committee-IR .,.. ,..... . ,- <.8 •: tea' ., . , , �e�i . .. x •. � f . , ., .. . . : 3., tr .. . N'b .�% ��� „�.,,�,f� M MEW 7 #DNI01 #DN/01 "#MDIV/01 #DN/01 Total program and funder spec budget includes United Way portion for psychological services of $4,000. No increases requested. M a Fees Le al Consultin Funding request of $7,000 same as 2004-2005 request. #DN/01 #DIV/OS 5/132005 BS . I ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE os - 26 - 2oa5 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION HRH OF VERO BEACH , INC / PHS ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HLDER , THIS CERTIFICATE DOES NT AMENDo EXTEND OR 227667 P : ( 866 ) 467 - 8730 F : ( 877 ) 538 - 8526 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW . P . 0 . BOX 29611 CHARLOTTE NC 28229 INSURERS AFFORDING COVERAGE INSURED INSURERA: Hartford Ins Co of the Southeast CHILDCARE RESOURCES OF INDIAN RIVER , INSURER e: INC . INSURER C: 1801 24TH ST . INSURER D: VERO BEACH FL 32960 INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED . NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, INTSRR I TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION DATE MMlDD DATE MM/DD/YY LIMITS GENERAL UIABUTYEACH OCCURRENCE ISI , 0 00 , 0 00 A COMMERCIAL GENERAL LIABILITY 21 SBA F P 5 9 7 3 10 / 14 / 05 10 / 14 / 06 1 FIRE DAMAGE (Any one fire) I S 3 0 0 , 0 0 0 CLAIMS MADE i X I OCCUR [MED EXP (Arty one person) I $ 10 , 000 X Business Liab ( PERSONAL & ADV INJURY 1 $ 1 , 000 , 000 I GENERAL AGGREGATE 1s2 , 000 , 000 GEN'L AGGREGATE LIMIT APPLIES PER: 1 PRODUCTS - COMP/OP AGG I s2 , 000 , 000 POLICY I JRA I X I LOC AUTOMOBILE LIA&CITY COMBINED SINGLE LIMIT A ANY AUTO 21 SBA F P 5 9 7 3 10 / 14 / 05 10 / 14 / 061 $ 1 , 000 , 000 (Ea accident) ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ X HIRED AUTOS BODILY INJURY X NON-OWNED AUTOS (Per accident) $ PROPERTY DAMAGE $ 'Per accident) ��GE LIABILITY I AUTO ONLY - EA ACCIDENT I $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY : AGG $ EXCESS LJA&UlY I EACH OCCURRENCE I $ OCCUR u CLAIMS MADE I AGGREGATE I $ I $ DEDUCTIBLE I I $ RETENTION $ $ WORKERS COMPENSATION AND WCRY STATU- O R EMPLOYERS' LLAMLTIY E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Those usual to the Insured ' s Operations . Indian River County is also an Additional Insured per the Business Liability Coverage Form SS0008 , CERTIFICATE HOLDER I X I ADDITIONAL INSURED; INSURER LETTER: A CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE ( 10 DAYS FOR NON- PAYMENT) TO THE CERTIFICATE Indian River County HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO 184 0 25th Street OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. Vero Beach , FL 32960 AUTHORIZED REPRESENT TE ACORD 25—S ( 7/97) 'Q' ACORD CORPORATION 1988 Community Child Care Resources, Inc. Psychological Services Children's Services Advisory Committee ORGANIZATION : Community Child Care Resources, Inc. PROGRAM : _ Psychological Services TABLE OF CONTENTS 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 Page # X TABLE OF CONTENTS (check list) 1 X COVER PAGE (with signatures) . 116 * 0 0 . . . . 3 A. ORGANIZATION CAPABILITY (one page maximum) X 1 . Mission and Vision of organization . . 1 0 1 0 1 a I a 0 4 * 1 6 0 0 00 0 4 0 0 0 0 4 9 . . . . . . . . . . . . . . . . . . . . . . . 4 2. Summary of expertise, accomplishments, and population served . . 4 B. PROGRAM NEED STATEMENT (one page maximum) X 1 . Program Need Statement . . . . . . , . . . . " , ' , * * @ 5 X 2 . Programs that address need and gaps in service . . . , . . . , . . 5 C. PROGRAM DESCRIPTION (two pages maximum) X 1 . Funding priority . . . 1 1 . 1 0 1 1 1 1 1 1 1 1 1 " 0 . . . . . * 0 0 , " 0 9 a * 0 0 0 . . a a . . . . . . * . . . . . . . . . . . X 2 . Description of program activities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . " 1 X 3 . Evidence that program strategy will work . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 X4 . Staffing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 X 5 . Awareness of program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 X 6 . Accessibility of program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 . . . . 0 6 0 . . . . . . . . . . . . . . . . . . 7 X D. MEASURABLE OUTCOMES (two pages maximum) . . . . . . . . . . . . . . . . . . . 011111 8 X E . COLLABORATION (one page maximum) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 F. PROGRAM EVALUATION (two pages maximum) X 1 . Demographics . . . 11 * 11 , 601 , 110 , " 1 , $ 11 X 2 . Measures . . . . . 4 , 0 * 0 , q " * , 0 . . . . . . . . . $ " 0 " " 11 X3 . Reporting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 . . . . . . . . . . . " 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 Application for 2005 -2006 service period 1 Community Child Care Resources, Inc. Psychological Services Children 's Services Advisory Committee X 1 . Financial Budget Forms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 J. FUNDER SPECIFIC/ADDITIONAL SHEETS K. APPENDIX Application for 2005 -2006 service period 2 SUPPORTING DOCUMENTS CHECKLIST RFP 7052 /Cover Page �- Application X- a List of current officers and directors Latest Financial Audit Report & Management Letter that conforms with the AICPA Audit Guide Most recent IRS Form 990, including all schedules Most recent Internal Financial Statement (i . e . : Balance Sheet and Operating Budget Staff Organizational Chart Most Recent Annual Report (if available) 501 (C)(3 ) IRS Exemption Letter Articles of Incorporation ✓ Agency ' s Bylaws Not For Profit Agency Certification Agency' s written policy regarding Affirmative Action ✓ Nepotism Statement Transportation Letter Insurance Certificates Authorization Release of Information x 3 `/ Testing Forms 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 184025 1h Street Vero Beach , Florida 32960-3365 Recipient : Childcare Resources of Indian River, Inc . 1801 24th Street Vero Beach , Florida 32960 Attention : Pam King , Executive Director 2 , Venue : Choice of Law. The validity, interpretation , construction , and effect of this Contract shall be in accordance with and governed by the laws of the State of Florida only. The location for settlement of any and all claims , controversies , or disputes , arising out of or relating to any part of this Contract, or any breach hereof, as well as any litigation between the parties , shall be Indian River county, Florida for claims brought in state court, and the Southern District of Florida for those claims justifiable in federal court. 3 . Entirety of Agreement. This Contract incorporates and includes all prior and contemporaneous negotiations , correspondence , conversations , agreements , and understandings applicable to the matters contained herein and the parties agree that there are no commitments , agreements , or understandings concerning the subject matter of this Contract that are not contained herein . Accordingly, it is agreed that no deviation from the terms hereof shall be predicated upon any prior representations or agreements , whether oral or written . It is further agreed that no modification , amendment or alteration in the terms and conditions contained herein shall be effective unless contained in a written document signed by both parties . 4 . Severability. In the event any provision of this Contract is determined to be unenforceable or invalid , such unenforceability or invalidity shall not affect the remaining provisions of this Contract, and every other 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 - . I ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE os - 26 - 2oa5 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION HRH OF VERO BEACH , INC / PHS ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HLDER , THIS CERTIFICATE DOES NT AMENDo EXTEND OR 227667 P : ( 866 ) 467 - 8730 F : ( 877 ) 538 - 8526 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW . P . 0 . BOX 29611 CHARLOTTE NC 28229 INSURERS AFFORDING COVERAGE INSURED INSURERA: Hartford Ins Co of the Southeast CHILDCARE RESOURCES OF INDIAN RIVER , INSURER e: INC . INSURER C: 1801 24TH ST . INSURER D: VERO BEACH FL 32960 INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED . NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, INTSRR I TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION DATE MMlDD DATE MM/DD/YY LIMITS GENERAL UIABUTYEACH OCCURRENCE ISI , 0 00 , 0 00 A COMMERCIAL GENERAL LIABILITY 21 SBA F P 5 9 7 3 10 / 14 / 05 10 / 14 / 06 1 FIRE DAMAGE (Any one fire) I S 3 0 0 , 0 0 0 CLAIMS MADE i X I OCCUR [MED EXP (Arty one person) I $ 10 , 000 X Business Liab ( PERSONAL & ADV INJURY 1 $ 1 , 000 , 000 I GENERAL AGGREGATE 1s2 , 000 , 000 GEN'L AGGREGATE LIMIT APPLIES PER: 1 PRODUCTS - COMP/OP AGG I s2 , 000 , 000 POLICY I JRA I X I LOC AUTOMOBILE LIA&CITY COMBINED SINGLE LIMIT A ANY AUTO 21 SBA F P 5 9 7 3 10 / 14 / 05 10 / 14 / 061 $ 1 , 000 , 000 (Ea accident) ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ X HIRED AUTOS BODILY INJURY X NON-OWNED AUTOS (Per accident) $ PROPERTY DAMAGE $ 'Per accident) ��GE LIABILITY I AUTO ONLY - EA ACCIDENT I $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY : AGG $ EXCESS LJA&UlY I EACH OCCURRENCE I $ OCCUR u CLAIMS MADE I AGGREGATE I $ I $ DEDUCTIBLE I I $ RETENTION $ $ WORKERS COMPENSATION AND WCRY STATU- O R EMPLOYERS' LLAMLTIY E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Those usual to the Insured ' s Operations . Indian River County is also an Additional Insured per the Business Liability Coverage Form SS0008 , CERTIFICATE HOLDER I X I ADDITIONAL INSURED; INSURER LETTER: A CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE ( 10 DAYS FOR NON- PAYMENT) TO THE CERTIFICATE Indian River County HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO 184 0 25th Street OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. Vero Beach , FL 32960 AUTHORIZED REPRESENT TE ACORD 25—S ( 7/97) 'Q' ACORD CORPORATION 1988