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HomeMy WebLinkAbout2005-328m C) 5 `? INDIAN RIVER COUNTY GRANT CONTRACT This Grant Contract ("Contract") entered into effective this day of October 2005 , by and between Indian River County, a political subdivision of the a of Florida ; 1840 25th Street, Vero Beach , Florida , 32960-3365 ; and St : Peters Human Services , Inc . , ( Recipient) , of: St . Peters Human Services , Inc. , 425038 th Avenue Vero Beach , Florida 32967 Boy's Development and Training Institute 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 - C) 5 `? INDIAN RIVER COUNTY GRANT CONTRACT This Grant Contract ("Contract") entered into effective this day of October 2005 , by and between Indian River County, a political subdivision of the a of Florida ; 1840 25th Street, Vero Beach , Florida , 32960-3365 ; and St : Peters Human Services , Inc . , ( Recipient) , of: St . Peters Human Services , Inc. , 425038 th Avenue Vero Beach , Florida 32967 Boy's Development and Training Institute 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 : THIRTY SIX THOUSAND , ONE HUNDRED SIX DOLLARS ($36 , 106 . 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 - � t 4 . Grant Funds and Payment . The approved Grant for the Grant Period is : THIRTY SIX THOUSAND , ONE HUNDRED SIX DOLLARS ($36 , 106 . 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 . Availabilitv 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: K. Barton , Clerk L1 P CR n � w r By. r Deputy Clerk P M1,.. P t1 �` Approved : J?Q=&6 os h A. Baird County Administrator Apgro d as to form and le al sufficiency: f f Marian E . Fell , A p�ant County Attorney RECIPIENT: LBy: St. Peces , Inc . - 4 - r � 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 . Availabilitv 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 - Organization : St. Peter ' s Human Services, Inc . Program : Boy ' s Development and Training Institute Founder: Children ' s Service Council , PROGRAM COVER PAGE Organization Name : Boy ' s Development and Training Institute Executive Director : Pastor Andrew Jefferson E-mail : stpetersschool2,bellsouth . net Address : 4250 38th Avenue Telephone : 772-562-6863 Vero Beach, FL 32967 Fax : 772 -5624920 Program'Director: Mr. Edward Coney E-mail: Same as above Address : Same as above Telephone : Same as above F Program Title : Boy ' s Developmental and Training Institute Priority Need Area Addressed. To reduce iuvenile delinquency and cre Brief Description of the Program : The program seeks to provide for school age children and teens ' access to a weekend training program that offers recreation academic supportself esteem character building and community services experience The program also provides positive role models through investors to equip the boys with knowledge about substance abuse violence and gap activity, SUMMARY REPORT — (Enter Information In The Black Cells Only) Amount Requested from Funder for 2005 / 06 : $ ;286 : 71 Total Proposed Program Budget for 2005 / 06 : $ 58 , 286 . 71 Percent of Total Program Budget : 100 . 00/0 Current Program Funding ( 2004 / 05 ) : $ 30 , 000 Dollar increase / ( decrease ) in request : $ 28 , 287 Percent increase / ( decrease ) in request * * : 94 . 3 % Unduplicated Number of Children to be served Individually : 50 Unduplicated Number of Adults to be served Individually : _ Unduplicated Number to be served via Group settings : 50 Total Program Cost per Client : m 582. 87 * *If request increased 5 % or more, briefly explain why : The program is requesting an additional $ 16. 094 . 00 for food as indicated in the variance section of the application i If these funds are being used to match another source, name the source and the $ amount : The Organization 's Board of Directors has approved this application on (dat Andrew Jefferson Name of President/Chair of the Board Si a Larry Taylor Name of Executive Director/CEO S gnature 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: K. Barton , Clerk L1 P CR n � w r By. r Deputy Clerk P M1,.. P t1 �` Approved : J?Q=&6 os h A. Baird County Administrator Apgro d as to form and le al sufficiency: f f Marian E . Fell , A p�ant County Attorney RECIPIENT: LBy: St. Peces , Inc . - 4 - Organization : St. Peter' s Human Services, Inc . Program : Boy' s Development and Training Institute Founder : Children' s Service Council . ORGANIZATION : St. Peter' s Human Services PROGRAM: Boy ' s Development and Training Institute 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. a X Section of the Proposal Pa e # X TABLE OF CONTENTS (check list) X COVER PAGE (with signatures) , 3 X A. ORGANIZATION CAPABILITY (one page maximum) X 1 . Mission and Vision of organization . . . . . . . . . . . . . . . . . . . 110 0 . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 X 2 . Summary of expertise, accomplishments, and population served . 4 X B. PROGRAM NEED STATEMENT (one page maximum) X_ 1 . Program Need Statement . . . , , . , , seem 0 . 9 9 0 . . . . . . . . . . . . . . . . . . . . . . . . . 5 X 2 . Programs that address need and gaps in service . . . . . . . . . . . 5. X C. PROGRAM DESCRIPTION (two pages maximum) X 1 . Funding priority . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . see m 6 X 2 . Description of program activities . . . . . . . . , , , . . 10 . 11 10 0 6 X 3 . Evidence that program strategy will work . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 X 4 . Staffmg . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 X 5 . Awareness of program " , . . . . . . 8 X 6 . Accessibility of program . , , , , , seem 8 X D. MEASURABLE OUTCOMES (two pages maximum) . 0 1 1 1 . . . . . . . . . . . . . . . . . . . . 9 X E. COLLABORATION (one page maximum) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 X F. PROGRAM EVALUATION (two pages maximum) X1 . Demographics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 X2 . Measures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 X3 . Reporting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 , 11 X G. TIMETABLE (one page maximum) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 X H. UNDUPLICATED CLIENT COUNT X 1 . Projections by Location . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 X 2 . Projections by Age Group . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 " Organization : St. Peter ' s Human Services, Inc . Program : Boy ' s Development and Training Institute Founder: Children ' s Service Council . X I. BUDGET FORMS X 1 . Financial Budget Forms15 . . . . . . . . . . . . . . . . . . . . a X J. FUNDER SPECIFIC/ADDITIONAL SHEETS X K. APPENDIX i 2 EXHIBIT A (Copy of complete Request for Proposal ) EXHIBIT - A - Organization : St. Peter' s Human Services, Inc . Program : Boy ' s Development and Training Institute Founder: Children ' s Service Council . 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 '/2" X 11 " paper and number each page . These directions and the graphic boxes may be deleted if space is needed . A. ORGANIZATION CAPABILITY (Entire Section A not to exceed one page) 1 . Provide the mission statement and vision of your organization. Mission Statement: St. Peter' s Human Services, Inc . ' s mission is to increase the success rate of high risk students by providing educational support, drug awareness , and character education through operation of a public school of choice . The organization works cooperatively with established social programs to assist the targeted population of Indian River County to become self sufficient members of society . Vision : The St . Peter' s Human Services Corporation is a non religious, non denominational organization in operation since December 1996 . The Agency ' s vision is to address social problems and needs in targeted areas of Indian River County, Florida. The agency is designed to provide short and long term services in the areas of affordable quality child/daycare services, before and after school childcare, public school of choice for children with special needs who may not be successful in the regular school system , youth intervention programs, and assisted living care for certain targeted groups . 2. Provide a brief summary of your organization including areas of expertise, accomplishments, and population served. Since its incorporation, the agency has provided quality daycare services for families with children ages zero to five years of age . The center also serves children who are Title 20 and ALPI Certified. The agency has a chartered public school of choice, serving 90 to 100 "at-risk" students of Indian River County . The Agency has also successfully implemented a Girl ' s Development and Training Program for the targeted population, ages 7 to 16 . The program' s highlights include organized drills, academic support, self esteem/character building, and exploration and exposure to educational and recreational activities through field trips and workshops . The Program is the only one of its -kind in Indian River County . 4 Organization : St, Peter' s Human Services, Development and Inc. Program : Boy ' s Deve Founder: Children ' s Service Council . Training Institute Be PROGRAM NEED STATEMENT (Entire Section B not to exceed one 1 • a) What is the unacceptable condition requiringcha page) C) Where do they live ? d) Pride local, state, or national trend data, wh las the reed ? source, that corroborates that this is an area of need, reference a. The unacceptable condition is juvenile delinquency that leads to further lives of crime, fancy, dropping out of school low self esteem, etco because the approach has been only lockup the offenders without changing the behaviors . to b. The children in need are the at-risk males between the ages of 7 and 16 who ar learners, have low self-esteem, stressful family conditions, and have exhibited e discouraged behaviors, such as school disciplinary referrals, chronic school truanc Problem suspensions, poor academic performance, a history of alcohol , tobacco and otted school her drugs, rebellion, running away, mental and emotional health issues and those with a o f delinquent behavior, hist of history ry C. In Indian River County, 90% of the at-risk males involved in the program are from the surrounding community. d. DJJ ' s Key Juvenile Crime Trends and Conditions states "In Fiscal Y juveniles were referred for delinquency. They were charged with co year 1999-2000, 104, 176 There was a 229 percent increase over the last decade injuvenile offenders g 150, 747 crimes . . , use0 . ' Florida, the fourth largest state, still tries more juveniles as adults than most states .erred for .. lg Percent of juvenile offenders can be classified as chronic . . . 4 families in Florida, who frequently change home neighborhoods high mobility of youth and increases delinquency . . . yoan schools, is a risk factor that: g people dont feel like they have consistent positive communities . . . Juvenile offenders in Florida typically come from single parent households and are alcohol ts or are doing poorly in school . . . three out of four youth in treyams truants, or drug use, 29% are emotionally disturbed, 20% have a diagnosed serious mental admit to illness, 9% are sex offenders and 5 % have developmental disabilities. " Bill Bankhead D Secretary stated, "We know from research the high risk factors for delinquency and the JJ oor school performance �y include truanc , famil instabili and rennin away, " 2a. Identify similar programs that are currently serving the needs of your targeted Population ; b) Explain how these existing programs are under-serving the to g Population of your program. geted There are two programs that serve the targeted population, however neither of thero ams structured to address the additional areas provided through the Boy ' s Development Instituteare 1 LHope Gird Youth Activity Center provides a day program for all youth, not just males . 1 b. The Programdoes not provide many of the services rendered by our program, i . e. mentoring, ity services, Life Skills, Drug Awareness and Character Education, overnight stay on ls, recreational, and academic support and tracking the boys for six months after l completion of the program through DJJ, schools and parents . Academy provides an alternative day program for suspended students from public hile the Boy ' s Institute seeks to serve the social , emotional and academic needs of the urin that all areas are addressed . 5 Organization : St. Peter ' s Human Services, Inc . Program : Boy ' s Development and Training Institute Founder: Children ' s Service Council , PROGRAM COVER PAGE Organization Name : Boy ' s Development and Training Institute Executive Director : Pastor Andrew Jefferson E-mail : stpetersschool2,bellsouth . net Address : 4250 38th Avenue Telephone : 772-562-6863 Vero Beach, FL 32967 Fax : 772 -5624920 Program'Director: Mr. Edward Coney E-mail: Same as above Address : Same as above Telephone : Same as above F Program Title : Boy ' s Developmental and Training Institute Priority Need Area Addressed. To reduce iuvenile delinquency and cre Brief Description of the Program : The program seeks to provide for school age children and teens ' access to a weekend training program that offers recreation academic supportself esteem character building and community services experience The program also provides positive role models through investors to equip the boys with knowledge about substance abuse violence and gap activity, SUMMARY REPORT — (Enter Information In The Black Cells Only) Amount Requested from Funder for 2005 / 06 : $ ;286 : 71 Total Proposed Program Budget for 2005 / 06 : $ 58 , 286 . 71 Percent of Total Program Budget : 100 . 00/0 Current Program Funding ( 2004 / 05 ) : $ 30 , 000 Dollar increase / ( decrease ) in request : $ 28 , 287 Percent increase / ( decrease ) in request * * : 94 . 3 % Unduplicated Number of Children to be served Individually : 50 Unduplicated Number of Adults to be served Individually : _ Unduplicated Number to be served via Group settings : 50 Total Program Cost per Client : m 582. 87 * *If request increased 5 % or more, briefly explain why : The program is requesting an additional $ 16. 094 . 00 for food as indicated in the variance section of the application i If these funds are being used to match another source, name the source and the $ amount : The Organization 's Board of Directors has approved this application on (dat Andrew Jefferson Name of President/Chair of the Board Si a Larry Taylor Name of Executive Director/CEO S gnature 3 Organization : St . Peter' s Human Services, Inc . Program . Boy ' s Development and Training Institute Founder : Children ' s Service Council . C . PROGRAM DESCRIPTION (Entire Section C, I — 6, not to exceed two pages) 1 . List Priority Needs area addressed . To reduce juvenile delinquency and crimes . 2 . Briefly describe program activities including location of services. Activities, Results , and Program Requirements : The following services will be provided/required by the program : tutoring and academic instruction, counseling (rehabilitative, social, mental and emotional) , drills for discipline training, character and self esteem building classes, conflict resolution and life skills classes, rap sessions to develop communication skills, recreational activities, field trips, mentoring, guest speakers, etc . Overall results : reduced juvenile delinquency and increased self esteem and responsibility . Process and Intended Outcomes — Client Involvement from start to finish : Referrals are made by schools, local churches, parents of enrolled boys and from other partnering agencies . The boy is accepted into the program and must participate on every level while attending . The boy ' s school attendance, records, etc . , are closely monitored and discussed during the duration of the program. Above is a list of those areas in which the boy will participate . Expected Outcomes and Changes : The outcomes generally include increased academic performance, decreased negative behavior, improved relationships among peers, increased community awareness and increased awareness of substance abuse addiction and HIV risk factors . The outcomes that would benefit the community include reduced juvenile delinquency, reduced crimes, increased responsibility as a citizen of the community, etc . Follow-U : After successful discharge, the boys are followed up on a monthly basis through DJJ for a total of six months . In addition, a concerned parent/school official is encouraged to contact the program director if there are any situations that arise that might be handled by the program director or counselors . The services are provided at St. Peter ' s Missionary Baptist Church, 4250 38th Avenue, GiffordNero Beach, FL 32967. The hours of operation are from Friday, 4 :30 p.m. through Saturday, 5 : 00 p .m. 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. The Boy ' s Development and Training Program addresses the need to reduce juvenile delinquency by providing a program for at-risk males who are affected by chemical additions, violence, poor family environment, and lack of social and academic skills, poor self esteem and other areas in need of improvement in a male youth ' s life . The focus of this program centers on addressing these young male issues along the same lines as DJJ, as indicated in the editorial written by the Secretary of DJJ, Bill Bankhead, where he stated (concerning the DJJ programs), "Individualized resources that meet the needs of the particular juvenile and his or her family are provided. These can include mental health counseling, substance abuse treatment and tutoring . . . to get everyone working together positively on issues and to give the kids a way up and out of failure. " When looking at the Boy ' s Institute, these areas have been addressed through a variety of mediums , discipline training, academic accountability, tutoring, parental involvement, community involvement (which increases ties to the community), mental health 6 Organization : St. Peter ' s Human Services, Inc . Program : Boy ' s Development and Trainin Founder : Children ' s Service Council . g Institute assessment and counseling, substance abuse awareness and referral (if necessary), etc . The DJJ report on Community Involvement indicated that evidence show that communities can deter juvenile crime by targeting the key risk factors of truancy, school failure, access to weapons, not enough positive activities to keep kids busy . It indicated that ,, , . . some of the same strategies that can prevent delinquency from ever happening in a child ' s life also can stop a juvenile offender from re -offending and recycling back into the delinquency system. " The articles closes with this statement : "No matter how good an individual juvenile justice program strives to be, a young P sooner or later returns to his home community . " St. Peter' s Boy ' s Development and Training Program assists in diverting the boys ' lives away from crime in their communities . It is a community program that develops community attachments for the youth while addressing the needs that placed the child at risk in the first place . According to DJJ Secretary " . . . outreach must be done in the neighborhoods where juvenile crime is hig . " ,Governor usBill h said of the successful outreaches, " . . . they focus on preserving the unity and emphasizing parental responsibility in dealing with troubled youth. " and integrity of family (YvElvv. dii . state . fl . us/features/runaways html .) Delinquency prevention is paramount to DJJ ' s plan, which includes three elements : targeting the most at risk, cooperation between community- based programs working with the government to approach families, and accountability through data collection and measurement of program success . The Boys institute does all three and goes bffmancial d in reventin or reversing the patterns and risk factors associated with delin uenc . staffing needed for your program, including required experience and estimated er week in program for each staff member and/or volunteers (This section should m with the information in the Position Listing on the Budget Narrative Worksheet). ministrator (PT, BA degree preferred, 2 yrs. Experience working with at-risk kids .) s the overall operation of the program, including data collection, quarterI reporting management of the program . Supervise and oversee all staff, includingbook-kee mand clerical, operations; must also meet with parents, teachers and outside agency representatives g� regarding the program . 1 — Program Operations Manager (PT, Minimum HS diploma/equivalency, training in child development, at Ieast 2 years experience in working with at-risk children). Responsible for overnight supervision of program. Will monitor institute teachers and trainers in addressing the social and educational needs of the enrollees, ensuring a safe, nurturing environment conducive to learning. House parenting for the weekend, discipline, drills, activities and planning of activities . Also work with institute staff, mentors and volunteers. 2 — Institute Teachers (Part time . Must have educational and experience in working with at-risk children. ) Will teach appropriate information addressing educational needs of enrollees during program hours including computer instruction and reading clinic ; will monitor progress and maintain records . 1 — Institute Prevention Coordinator (BA degree in related field and/or 2 years of experience in social setting working with youth. Knowledge of children and teaching basic skills . ) Recruitment and new referrals, handle data, planning, parent training, discipline, counseling and assist with data collection from schools including school visits, on-site monitoring and coordination with teachers . 7 Organization : St. Peter' s Human Services, Inc . Program : Boy' s Development and Training Institute Founder : Children' s Service Council . ORGANIZATION : St. Peter' s Human Services PROGRAM: Boy ' s Development and Training Institute 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. a X Section of the Proposal Pa e # X TABLE OF CONTENTS (check list) X COVER PAGE (with signatures) , 3 X A. ORGANIZATION CAPABILITY (one page maximum) X 1 . Mission and Vision of organization . . . . . . . . . . . . . . . . . . . 110 0 . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 X 2 . Summary of expertise, accomplishments, and population served . 4 X B. PROGRAM NEED STATEMENT (one page maximum) X_ 1 . Program Need Statement . . . , , . , , seem 0 . 9 9 0 . . . . . . . . . . . . . . . . . . . . . . . . . 5 X 2 . Programs that address need and gaps in service . . . . . . . . . . . 5. X C. PROGRAM DESCRIPTION (two pages maximum) X 1 . Funding priority . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . see m 6 X 2 . Description of program activities . . . . . . . . , , , . . 10 . 11 10 0 6 X 3 . Evidence that program strategy will work . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 X 4 . Staffmg . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 X 5 . Awareness of program " , . . . . . . 8 X 6 . Accessibility of program . , , , , , seem 8 X D. MEASURABLE OUTCOMES (two pages maximum) . 0 1 1 1 . . . . . . . . . . . . . . . . . . . . 9 X E. COLLABORATION (one page maximum) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 X F. PROGRAM EVALUATION (two pages maximum) X1 . Demographics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 X2 . Measures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 X3 . Reporting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 , 11 X G. TIMETABLE (one page maximum) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 X H. UNDUPLICATED CLIENT COUNT X 1 . Projections by Location . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 X 2 . Projections by Age Group . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 " Organization : St. Peter ' s Human Services, Inc . Program : Boy ' s Development and Training Institute Founder: Children ' s Service Council . X I. BUDGET FORMS X 1 . Financial Budget Forms15 . . . . . . . . . . . . . . . . . . . . a X J. FUNDER SPECIFIC/ADDITIONAL SHEETS X K. APPENDIX i 2 Organization : St. Peter' s Human Services, Inc . Program : Boy ' s Development and Training Institute Founder: Children ' s Service Council . 5. How will the target population be made aware of the program ? The program continues to provide awareness through word-ofemouth advertisement, flyers, local churches, parents , and through collaboration with other partnening agencies , 6 . How will the program be accessible to target population (i. e. , location , transportation, hours of operation) ? The St . Peter ' s Boy ' s Development and Training Institute is located in the heart of 90% of the targeted population. The address is St. Peter ' s Missionary Baptist Church, 4250 38th Avenue, Vero Beach, FL . Transportation is provided by the parents and Institute staff when needed. The Lprogram iso en from Friday, 4 : 30 p .m . to Saturday, 5 : 00 p.m. 8 Organization : St. Peter ' s Human Services, Inc . Program : Boy ' s Development and Training Institute Founder : Children ' s Service Council . D. MEASURABLE OUTCOMES (Entire Section D not to exceed two pages) OUTCOMES ACTIVITIES Fall elements or the Measurable Outcomes Add the tasks to accom hsh the OutcomesE # 1 : Improved academic Provide tutoring each week to enrolled boys performance . Seventy- five (75 %) of the including a designated study hour each week. program .participants will increase their GPA Measuring tools — Brigance Comprehensive (grade point average) by a minimum of 25 % by Inventory of Basic Skills pre-post test, report the end of the school term each year. cards and progress reports . OJBECTIVE 42 : Decreased Provide rap sessions for enrolled boys weekly , negative/disruptive behavior. Sixty-five Provide mentoring with positive role models percent (65 %) of the participants will reduce on a weekly basis. Provide character/self the number of school behavior referrals for esteem training session, and conflict resolution. disruptive behavior, including bullying and Measuring tools : Entrance Behavior aggression toward peers and adults, as Description Report — reviewed beginning, mid measured by school disciplinary records and and end of year-collect and monitor school weekly parent behavior report forms . behavior and discipline forms . OBJECTIVE #3 : Raise awareness level of Invite guest speakers from the Substance chemical addictions , STD and HIV for enrolled Abuse Council, Indian River County Health boys . Eighty-five percent of the boys will show Department, and other agencies. Training increased knowledge of drug abuse addictions sessions will be held by Substance Abuse and effects, STD, and HIV by the end of the Council, IRC Health Department, and other program each year as indicated in pre and post Agencies that will address alcohol, drug abuse, surveys and questionnaires . STD, HIV, abstinence, etc . Measuring tools : pre-post tests/questionnaire . The Institute will hold a minimum of four sessions per year. z OBJECTIVE #4 : Increase community Program participants will take part in at least awareness and develop community attachments three major community service oriented for youth through participation in community projects each year, i . e . Habitat for Humanity, service projects . Faith Based projects and community clean-up events . 9 Organization : St. Peter' s Human Services, Inc . Program : Boy ' s Development and Training Institute Founder: Children ' s Service Council . 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 '/2" X 11 " paper and number each page . These directions and the graphic boxes may be deleted if space is needed . A. ORGANIZATION CAPABILITY (Entire Section A not to exceed one page) 1 . Provide the mission statement and vision of your organization. Mission Statement: St. Peter' s Human Services, Inc . ' s mission is to increase the success rate of high risk students by providing educational support, drug awareness , and character education through operation of a public school of choice . The organization works cooperatively with established social programs to assist the targeted population of Indian River County to become self sufficient members of society . Vision : The St . Peter' s Human Services Corporation is a non religious, non denominational organization in operation since December 1996 . The Agency ' s vision is to address social problems and needs in targeted areas of Indian River County, Florida. The agency is designed to provide short and long term services in the areas of affordable quality child/daycare services, before and after school childcare, public school of choice for children with special needs who may not be successful in the regular school system , youth intervention programs, and assisted living care for certain targeted groups . 2. Provide a brief summary of your organization including areas of expertise, accomplishments, and population served. Since its incorporation, the agency has provided quality daycare services for families with children ages zero to five years of age . The center also serves children who are Title 20 and ALPI Certified. The agency has a chartered public school of choice, serving 90 to 100 "at-risk" students of Indian River County . The Agency has also successfully implemented a Girl ' s Development and Training Program for the targeted population, ages 7 to 16 . The program' s highlights include organized drills, academic support, self esteem/character building, and exploration and exposure to educational and recreational activities through field trips and workshops . The Program is the only one of its -kind in Indian River County . 4 Organization : St, Peter' s Human Services, Development and Inc. Program : Boy ' s Deve Founder: Children ' s Service Council . Training Institute Be PROGRAM NEED STATEMENT (Entire Section B not to exceed one 1 • a) What is the unacceptable condition requiringcha page) C) Where do they live ? d) Pride local, state, or national trend data, wh las the reed ? source, that corroborates that this is an area of need, reference a. The unacceptable condition is juvenile delinquency that leads to further lives of crime, fancy, dropping out of school low self esteem, etco because the approach has been only lockup the offenders without changing the behaviors . to b. The children in need are the at-risk males between the ages of 7 and 16 who ar learners, have low self-esteem, stressful family conditions, and have exhibited e discouraged behaviors, such as school disciplinary referrals, chronic school truanc Problem suspensions, poor academic performance, a history of alcohol , tobacco and otted school her drugs, rebellion, running away, mental and emotional health issues and those with a o f delinquent behavior, hist of history ry C. In Indian River County, 90% of the at-risk males involved in the program are from the surrounding community. d. DJJ ' s Key Juvenile Crime Trends and Conditions states "In Fiscal Y juveniles were referred for delinquency. They were charged with co year 1999-2000, 104, 176 There was a 229 percent increase over the last decade injuvenile offenders g 150, 747 crimes . . , use0 . ' Florida, the fourth largest state, still tries more juveniles as adults than most states .erred for .. lg Percent of juvenile offenders can be classified as chronic . . . 4 families in Florida, who frequently change home neighborhoods high mobility of youth and increases delinquency . . . yoan schools, is a risk factor that: g people dont feel like they have consistent positive communities . . . Juvenile offenders in Florida typically come from single parent households and are alcohol ts or are doing poorly in school . . . three out of four youth in treyams truants, or drug use, 29% are emotionally disturbed, 20% have a diagnosed serious mental admit to illness, 9% are sex offenders and 5 % have developmental disabilities. " Bill Bankhead D Secretary stated, "We know from research the high risk factors for delinquency and the JJ oor school performance �y include truanc , famil instabili and rennin away, " 2a. Identify similar programs that are currently serving the needs of your targeted Population ; b) Explain how these existing programs are under-serving the to g Population of your program. geted There are two programs that serve the targeted population, however neither of thero ams structured to address the additional areas provided through the Boy ' s Development Instituteare 1 LHope Gird Youth Activity Center provides a day program for all youth, not just males . 1 b. The Programdoes not provide many of the services rendered by our program, i . e. mentoring, ity services, Life Skills, Drug Awareness and Character Education, overnight stay on ls, recreational, and academic support and tracking the boys for six months after l completion of the program through DJJ, schools and parents . Academy provides an alternative day program for suspended students from public hile the Boy ' s Institute seeks to serve the social , emotional and academic needs of the urin that all areas are addressed . 5 Organization : St. Peter' s Human Services, Inc . Program : Boy ' s Development and Training Institute Founder : Children' s Service Council . 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 Substance Abuse Council Drug Awareness Sheriff s Department Scared Straight Jail Tour IRC Health Department Sexually Transmitted Diseases Gifford Youth Activity Center Seminar, "Raising Them Chaste" Black Faith-Based Organization, Inc . Basketball Tournament IRC Mental Health Center Referrals — Individual and Family Services 10 Organization : St . Peter' s Human Services, Inc . Program : Boy ' s Development and Training Institute Founder: Children ' s Service Council , F. PROGRAM EVALUATION (Entire Section F not to exceed two pages) 1 . DEMOGRAPHICS : What information (data elements) will you need to collect in order to accurately describe your target population including demographics (age, gender, and ethnic background} required by the funder in Section H? What are the pieces of information that qualify them for your target population ? How do you document their need for services or their " unacceptable condition requiring change" from Section B19 The information to be collected includes : name, age ethnic background, birth date and grade . To qualify for the target population, a prospective enrollee will be at-risk for at least two of the following conditions : At-risk males between the ages of 7 and 16 who have exhibited at least two of the problem behaviors as follows : school disciplinary referrals, chronic school truancy, repeated school suspensions, poor academic performance , a history of alcohol , tobacco and other drugs , rebellion, running away, mental and emotional health issues and those with a history of delinquent behavior. The unacceptable condition is juvenile delinquency and is documented through DJJ reports, school reports , parent reports, etc . This shall be documented and maintained .through a database andspreadsheet programs . 7achieved URES : What data elements will you need to collect to show that you have (or made progress toward) your Measurable Outcomes in Section D ? What items are you using as measures (grades, survey scores, attendance, absences,els) 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 ? Data will be collected from participants via progress reports/report cards on a nine week basis . Copies of schedules of activities listing the study hour, rap sessions and dates and times of guest speakers will be maintained on location. An entrance description of behaviors will be maintained and reviewed quarterly for improvement. Upon exiting a program, a summary of progress made while attending the program will be documented. Measurement items include grades , attendance sheets, progress reports, school conduct codes report, pre and post test reports, counselor reports, prevention activity attendance sheets, etc . The progress report/report cards will be collected every nine weeks and at the end of each semester. The schedule of activities will be collected on an ongoing basis. The entrance and exit behavior description will be collected upon entering and ` exiting the program. Progress notes on behavior improvement will be documented quarterly or as needed. After successful discharge, there will be a monthly follow-up for six months via parents, school and DJJ. 7program9 RTING : What will you do with this information to show that change has ed? How will you use or present these results to the consumer, the funder, the m , and the community ? How will you use this information to improve your The data will be compiled in a notebook under each activity and also copies of the progress/report cards will be placed in each enrollee ' s file . The information will be provided 11 Organization : St . Peter' s Human Services, Inc . Program . Boy ' s Development and Training Institute Founder : Children ' s Service Council . C . PROGRAM DESCRIPTION (Entire Section C, I — 6, not to exceed two pages) 1 . List Priority Needs area addressed . To reduce juvenile delinquency and crimes . 2 . Briefly describe program activities including location of services. Activities, Results , and Program Requirements : The following services will be provided/required by the program : tutoring and academic instruction, counseling (rehabilitative, social, mental and emotional) , drills for discipline training, character and self esteem building classes, conflict resolution and life skills classes, rap sessions to develop communication skills, recreational activities, field trips, mentoring, guest speakers, etc . Overall results : reduced juvenile delinquency and increased self esteem and responsibility . Process and Intended Outcomes — Client Involvement from start to finish : Referrals are made by schools, local churches, parents of enrolled boys and from other partnering agencies . The boy is accepted into the program and must participate on every level while attending . The boy ' s school attendance, records, etc . , are closely monitored and discussed during the duration of the program. Above is a list of those areas in which the boy will participate . Expected Outcomes and Changes : The outcomes generally include increased academic performance, decreased negative behavior, improved relationships among peers, increased community awareness and increased awareness of substance abuse addiction and HIV risk factors . The outcomes that would benefit the community include reduced juvenile delinquency, reduced crimes, increased responsibility as a citizen of the community, etc . Follow-U : After successful discharge, the boys are followed up on a monthly basis through DJJ for a total of six months . In addition, a concerned parent/school official is encouraged to contact the program director if there are any situations that arise that might be handled by the program director or counselors . The services are provided at St. Peter ' s Missionary Baptist Church, 4250 38th Avenue, GiffordNero Beach, FL 32967. The hours of operation are from Friday, 4 :30 p.m. through Saturday, 5 : 00 p .m. 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. The Boy ' s Development and Training Program addresses the need to reduce juvenile delinquency by providing a program for at-risk males who are affected by chemical additions, violence, poor family environment, and lack of social and academic skills, poor self esteem and other areas in need of improvement in a male youth ' s life . The focus of this program centers on addressing these young male issues along the same lines as DJJ, as indicated in the editorial written by the Secretary of DJJ, Bill Bankhead, where he stated (concerning the DJJ programs), "Individualized resources that meet the needs of the particular juvenile and his or her family are provided. These can include mental health counseling, substance abuse treatment and tutoring . . . to get everyone working together positively on issues and to give the kids a way up and out of failure. " When looking at the Boy ' s Institute, these areas have been addressed through a variety of mediums , discipline training, academic accountability, tutoring, parental involvement, community involvement (which increases ties to the community), mental health 6 Organization : St. Peter ' s Human Services, Inc . Program : Boy ' s Development and Trainin Founder : Children ' s Service Council . g Institute assessment and counseling, substance abuse awareness and referral (if necessary), etc . The DJJ report on Community Involvement indicated that evidence show that communities can deter juvenile crime by targeting the key risk factors of truancy, school failure, access to weapons, not enough positive activities to keep kids busy . It indicated that ,, , . . some of the same strategies that can prevent delinquency from ever happening in a child ' s life also can stop a juvenile offender from re -offending and recycling back into the delinquency system. " The articles closes with this statement : "No matter how good an individual juvenile justice program strives to be, a young P sooner or later returns to his home community . " St. Peter' s Boy ' s Development and Training Program assists in diverting the boys ' lives away from crime in their communities . It is a community program that develops community attachments for the youth while addressing the needs that placed the child at risk in the first place . According to DJJ Secretary " . . . outreach must be done in the neighborhoods where juvenile crime is hig . " ,Governor usBill h said of the successful outreaches, " . . . they focus on preserving the unity and emphasizing parental responsibility in dealing with troubled youth. " and integrity of family (YvElvv. dii . state . fl . us/features/runaways html .) Delinquency prevention is paramount to DJJ ' s plan, which includes three elements : targeting the most at risk, cooperation between community- based programs working with the government to approach families, and accountability through data collection and measurement of program success . The Boys institute does all three and goes bffmancial d in reventin or reversing the patterns and risk factors associated with delin uenc . staffing needed for your program, including required experience and estimated er week in program for each staff member and/or volunteers (This section should m with the information in the Position Listing on the Budget Narrative Worksheet). ministrator (PT, BA degree preferred, 2 yrs. Experience working with at-risk kids .) s the overall operation of the program, including data collection, quarterI reporting management of the program . Supervise and oversee all staff, includingbook-kee mand clerical, operations; must also meet with parents, teachers and outside agency representatives g� regarding the program . 1 — Program Operations Manager (PT, Minimum HS diploma/equivalency, training in child development, at Ieast 2 years experience in working with at-risk children). Responsible for overnight supervision of program. Will monitor institute teachers and trainers in addressing the social and educational needs of the enrollees, ensuring a safe, nurturing environment conducive to learning. House parenting for the weekend, discipline, drills, activities and planning of activities . Also work with institute staff, mentors and volunteers. 2 — Institute Teachers (Part time . Must have educational and experience in working with at-risk children. ) Will teach appropriate information addressing educational needs of enrollees during program hours including computer instruction and reading clinic ; will monitor progress and maintain records . 1 — Institute Prevention Coordinator (BA degree in related field and/or 2 years of experience in social setting working with youth. Knowledge of children and teaching basic skills . ) Recruitment and new referrals, handle data, planning, parent training, discipline, counseling and assist with data collection from schools including school visits, on-site monitoring and coordination with teachers . 7 Organization: St. Peter' s Human Services, Inc . Program : Boy ' s Development and Training Institute Founder : Children' s Service Council , upon request to any requesting agency, collaborative partner and the Human Service Board of Directors . In areas where the increase in a positive attribute is low or minimal, the program director and board will determine and research new ways to implement a more substantial increase in the positive attribute . It will also be utilized to determine what is working so that it can be continued. 12 Organization : St. Peter' s Human Services, Inc . Program : Boy ' s Development and Training Institute Founder: Children ' s Service Council . G. TIMETABLE (Section G not to exceed one page) 1 . List the major action steps , activities, or cycles of events that will occur within the program year. New programs should include any start-up planning that may occur outside the funding-year. In completing the timetable, review information detailed in prior sections. Month/Period Activities Weekly Tutoring — study hour and classes 9 : 00 a.m. — 12 : 00 p.m. Saturdays . Weekly Character/self esteem building sessions ; community activities; conflict resolution. As needed — ongoing Life Skills sessions ; rap sessions Each nine weeks Academic improvement (progress reports and report cards) Weekly — ongoing Reducing negative behaviors — through rap sessions, field trips, seminars, training and mentoring Weekly Recreational activities and drills Weekly Institute counseling and referrals i 13 Organization : St. Peter' s Human Services, Inc . Program : Boy ' s Development and Training Institute Founder: Children ' s Service Council . 5. How will the target population be made aware of the program ? The program continues to provide awareness through word-ofemouth advertisement, flyers, local churches, parents , and through collaboration with other partnening agencies , 6 . How will the program be accessible to target population (i. e. , location , transportation, hours of operation) ? The St . Peter ' s Boy ' s Development and Training Institute is located in the heart of 90% of the targeted population. The address is St. Peter ' s Missionary Baptist Church, 4250 38th Avenue, Vero Beach, FL . Transportation is provided by the parents and Institute staff when needed. The Lprogram iso en from Friday, 4 : 30 p .m . to Saturday, 5 : 00 p.m. 8 Organization : St. Peter ' s Human Services, Inc . Program : Boy ' s Development and Training Institute Founder : Children ' s Service Council . D. MEASURABLE OUTCOMES (Entire Section D not to exceed two pages) OUTCOMES ACTIVITIES Fall elements or the Measurable Outcomes Add the tasks to accom hsh the OutcomesE # 1 : Improved academic Provide tutoring each week to enrolled boys performance . Seventy- five (75 %) of the including a designated study hour each week. program .participants will increase their GPA Measuring tools — Brigance Comprehensive (grade point average) by a minimum of 25 % by Inventory of Basic Skills pre-post test, report the end of the school term each year. cards and progress reports . OJBECTIVE 42 : Decreased Provide rap sessions for enrolled boys weekly , negative/disruptive behavior. Sixty-five Provide mentoring with positive role models percent (65 %) of the participants will reduce on a weekly basis. Provide character/self the number of school behavior referrals for esteem training session, and conflict resolution. disruptive behavior, including bullying and Measuring tools : Entrance Behavior aggression toward peers and adults, as Description Report — reviewed beginning, mid measured by school disciplinary records and and end of year-collect and monitor school weekly parent behavior report forms . behavior and discipline forms . OBJECTIVE #3 : Raise awareness level of Invite guest speakers from the Substance chemical addictions , STD and HIV for enrolled Abuse Council, Indian River County Health boys . Eighty-five percent of the boys will show Department, and other agencies. Training increased knowledge of drug abuse addictions sessions will be held by Substance Abuse and effects, STD, and HIV by the end of the Council, IRC Health Department, and other program each year as indicated in pre and post Agencies that will address alcohol, drug abuse, surveys and questionnaires . STD, HIV, abstinence, etc . Measuring tools : pre-post tests/questionnaire . The Institute will hold a minimum of four sessions per year. z OBJECTIVE #4 : Increase community Program participants will take part in at least awareness and develop community attachments three major community service oriented for youth through participation in community projects each year, i . e . Habitat for Humanity, service projects . Faith Based projects and community clean-up events . 9 Organization : St. Peter ' s Human Services, Inc . Program : Boy ' s Development and Training Institute Founder : Children ' s Service Council . H. PROJECTIONS FOR UNDUPLICATED CLIENTS Number of Unduplicated Clients by Location :,Last I+yscal Years Current Fiscal Year Location Actual 2004 3/2004,5Budget 2004/05 ` Projections !06 .. . . K Unduplicated Clients Unduplicated Clients Unduplicated Clients N. Indian River County 40 45 50 S . Indian River County - - - Indian River Co. Total 40 45 50 Greater Stuart - - - Hobe Sound - - - Indiantown - - - Jensen Beach - - Palm City - - Martin County Total - - Fort Pierce Port Saint Lucie - - - St. Lucie Co. Total - - - Other Locations TOTAL SERVED 40 45 50 Inivd ` Gro p Individual Group 1111 rrri 0 to 4 - (Pre-school) - - - - - - 5 to 10 - (Elementary) 21 22 24 11 to 14 - (Middle) 22 23 26 15 to 18 - (High School) - - - - - - Total Children - 43 - 45 - 50 19 to 59 - (Adults) - - - - - - 60 + ( Seniors) - - - - - Total Adults - - - - - TOTAL SERVED - 43 - 45 - 50 14 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 Specific Budget Forms. AGENCY/PROGRAM NAME : Boy's Development & Training Institute FUNDER : Children 's Services Council CAUTION : Do not enter any figures where a cell is colored in dark blue - Formulas and/or links are in place. Gray areas should be used for calculations and to write information only. OKAY AREAS fOR REVENUES Proposed Total Program Funder Specific TotalAgency Budget Budget Budget 1 Children's Services Council-St. Lucie 2 Children 's Services Council-Martin 3 Advisory Committee-Indian River 581286. 71 58,286.71 58,286. 71 4 United Way-St Lucie County 5 United Wa -Martin County 6 United Wa -Indian River County 7 Department of Children $ Families 8 County Funds 9 Contributions-Cash 10 Pro ram Fees 11 Fund Raising Events-Net 12 Sales to Public - Net 13 Membership Dues 14 Investment Income 15 Miscellaneous 16 Legacies & Bequests 17 Funds from Other Sources 18 Reserve Funds Used for Operating 19 In-Kind Donations (Not included in total) 20 TOTAL REVENUES (doesn't include line 19) $ 58 , 286. 71 $ 582286 . 71 $58 ,286 . 71 B D EXPENDITURES GRAY AREAS FOR Proposed Total Program Funder S ecl!fic AGENCY USE ONLY p Total agency :: s" ca< „wa Budget Budget '` ' " 'Budde 21 Salaries - (must complete chart on next page) 36, 872 . 00 36, 872. 00 36,872. 00 Salary . 22 FICA - Total salaries x 0 . 0765 7.65% 21820.71 2, 820. 71 21820.71 e firemen - Annual pension tor qua I le 23 staff 0. 00 Life/Heal - e Ica en a o -term 24 Disab. Workers Compensation - # employees x 0. 00 25 rate Honda Unemployment - prole e 0 . 00 26 employees x $7, 000 x UCT-6 rate 0 . 00 SALARIES A _ e = v ti POSITION UST/NG Gross Annua! portoir of Salary ori Proposed ' c % of Gross Arrnua! Sa/erygrom Funder Speclfle Budget x Salary Position Title / Total Hrs/wk (Agency); udl�At . - 5/1721x15 B-1 Organization : St. Peter' s Human Services, Inc . Program : Boy ' s Development and Training Institute Founder : Children' s Service Council . 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 Substance Abuse Council Drug Awareness Sheriff s Department Scared Straight Jail Tour IRC Health Department Sexually Transmitted Diseases Gifford Youth Activity Center Seminar, "Raising Them Chaste" Black Faith-Based Organization, Inc . Basketball Tournament IRC Mental Health Center Referrals — Individual and Family Services 10 Organization : St . Peter' s Human Services, Inc . Program : Boy ' s Development and Training Institute Founder: Children ' s Service Council , F. PROGRAM EVALUATION (Entire Section F not to exceed two pages) 1 . DEMOGRAPHICS : What information (data elements) will you need to collect in order to accurately describe your target population including demographics (age, gender, and ethnic background} required by the funder in Section H? What are the pieces of information that qualify them for your target population ? How do you document their need for services or their " unacceptable condition requiring change" from Section B19 The information to be collected includes : name, age ethnic background, birth date and grade . To qualify for the target population, a prospective enrollee will be at-risk for at least two of the following conditions : At-risk males between the ages of 7 and 16 who have exhibited at least two of the problem behaviors as follows : school disciplinary referrals, chronic school truancy, repeated school suspensions, poor academic performance , a history of alcohol , tobacco and other drugs , rebellion, running away, mental and emotional health issues and those with a history of delinquent behavior. The unacceptable condition is juvenile delinquency and is documented through DJJ reports, school reports , parent reports, etc . This shall be documented and maintained .through a database andspreadsheet programs . 7achieved URES : What data elements will you need to collect to show that you have (or made progress toward) your Measurable Outcomes in Section D ? What items are you using as measures (grades, survey scores, attendance, absences,els) 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 ? Data will be collected from participants via progress reports/report cards on a nine week basis . Copies of schedules of activities listing the study hour, rap sessions and dates and times of guest speakers will be maintained on location. An entrance description of behaviors will be maintained and reviewed quarterly for improvement. Upon exiting a program, a summary of progress made while attending the program will be documented. Measurement items include grades , attendance sheets, progress reports, school conduct codes report, pre and post test reports, counselor reports, prevention activity attendance sheets, etc . The progress report/report cards will be collected every nine weeks and at the end of each semester. The schedule of activities will be collected on an ongoing basis. The entrance and exit behavior description will be collected upon entering and ` exiting the program. Progress notes on behavior improvement will be documented quarterly or as needed. After successful discharge, there will be a monthly follow-up for six months via parents, school and DJJ. 7program9 RTING : What will you do with this information to show that change has ed? How will you use or present these results to the consumer, the funder, the m , and the community ? How will you use this information to improve your The data will be compiled in a notebook under each activity and also copies of the progress/report cards will be placed in each enrollee ' s file . The information will be provided 11 Type the Organization and Program Name Program Director/Administrator - 10 hrs 7 , 800. 00 71800. 00 79800.00 100 . 00% Propram Operations Manager - 25 hrs 15 , 500. 00 15, 500. 00 15 , 500. 00 100 . 00% Institute Prevention Coordinator - 12 hrs 91360 . 00 91360. 00 9, 360. 00 100 . 00% (2 ) Institute Trainers/Teachers - 6 hrs 4 , 212 . 00 41212 . 00 41212 . 00 100. 00% #DIV/0 ! #DIV/0 ! #DIV/0 ! #DIV/0 ! #DIV/0 ! #DIV/0 ! #DIV/o ! #DIV/0 ! #DIV/0 ! #DIV/0 ! #DIV/0 ! #DIV/0 ! #DIV/0 ! #DIV/0 ! #DIV/0 ! #DIV/0 ! Remaining positions throughout the agency Total Salaries 1 $36 , 872 . 001 $360872 . 00 $360872. 00 100. 00% FRINGE BENEFITS DETAIL a (Funder Specific Budget Funder Is Workers Unemp D e f c Pension loyme Total Fringes funder Column C only, from line 22 to 27) Specific FICA 7,65% A x %1 Health Ins, Position Title ! Total HrsAvk ` Budget Compens. nt Compens. Specific Program Director/Administrator - 10 hrs 7, 800 . 00 596. 70 596.70 Propram Operations Manager - 25 hrs 15 . 500 . 00 11185. 75 19185. 75 Institute Prevention Coordinator - 12 hrs 9 , 360 . 00 716 . 04 716.04 (2) Institute Trainers/Teachers - 6 hrs 4 , 212 . 00 322 .22 322 .22 0 0 . 00 0. 00 0 .00 0 0 . 00 0 . 00 0 . 00 0 0 . 00 0 . 00 0. 00 0 0 . 00 0 . 00 0 . 00 0 0 . 00 0 . 00 0. 00 0 0 . 00 0. 00 0 . 00 0 0 . 00 0 . 00 0 . 00 0 0 . 00 0. 00 0. 00 0 0 . 00 0 . 00 0. 00 0 0. 00 0 . 00 - 0 . 00 0 0. 00 0 . 00 0 . 00 0 0 . 00 0 .00 10 . 00 0 0 . 00 0 . 00 0 . 00 0 0 . 00 0 . 00 0. 00 0 0 . 00 0 .00 0. 00 0 0 . 001 0. 00 0. 00 Total Funder Request Fringe Benefits 1 $ 36P872. 001 $2 , 820. 71 $0. 001 $0. 001 $ 0. 001 $0 . 00 $2, 820. 71 A _ B C ID EXPENDITURES ORAYAREAS FOR Proposed Total Program Funder Specific Total Agency AGENCY SHOW MTTNL TO - Budget _ � Budget Budget 27 Travel-Daily # of Staff x average # of miles/wk x 50 wks x $ = Estimated Daily Travel/Mileage Reimb . 28 Travel/conferences/Training 5/17/2005 - 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 Office supplies ( monthly average x 12 months = estimated cost of office supplies based on present history. 30 Telephone # 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 • Quarterly Mailing of Newsletter • Special events , etc. • Bulk mailings - appeals 32 Utilities • Electricity ($ x 12 months) • Water/Sewer ($ x 12 months) • Garbage ($ x 12 months) 33 Occupancy (Building & Grounds ) • Mortgage/Rent ($ x 12 months ) • Janitorial ($ x 12 months) • Grounds Maint. ( $ x 12 months) • Real Estate Taxes 34 Printing & Publications Quarterly Newsletter ($ x 4) Letterheads , Envelopes , etc. Fundraising materials Other 35 Subscription/Dues/Memberships • Membership to National Organization • Dues • Subscriptions to Newspapers/magazines , etc. 36 Insurance • Directors/Officers Liab . • Commercial/General Insurance • Bond Ins. • Auto Insurance 37 Equipment: Rental & Maintenance Copier lease ($ x 12 months) c Meter lease ($ x 12 months) Copier Maintenance ($ x 12 months) Computer Maintenance ( $ x 12 months) Other 38 Advertising 500. 00 500.00 500. 00 • Newspaper ads • Fundraising ads/promotions • Other (vacancies) 39 Equipment Purchases : Capital Expense Computer/monitor (# x $) Laser Printer 40 Professional Fees ( Legal, Consulting ) • Legal advice ( estimated #hrs x $) • Consultant fees • Other 41 Books/Educational Materials 500 . 00 500. 00 500 . 00 • Books/videos • Materials ($ x staff) 42 Food & Nutrition 16,094. 00 16, 094. 00 16,094. 00 5n 7r2005 s-� Organization: St. Peter' s Human Services, Inc . Program : Boy ' s Development and Training Institute Founder : Children' s Service Council , upon request to any requesting agency, collaborative partner and the Human Service Board of Directors . In areas where the increase in a positive attribute is low or minimal, the program director and board will determine and research new ways to implement a more substantial increase in the positive attribute . It will also be utilized to determine what is working so that it can be continued. 12 Organization : St. Peter' s Human Services, Inc . Program : Boy ' s Development and Training Institute Founder: Children ' s Service Council . G. TIMETABLE (Section G not to exceed one page) 1 . List the major action steps , activities, or cycles of events that will occur within the program year. New programs should include any start-up planning that may occur outside the funding-year. In completing the timetable, review information detailed in prior sections. Month/Period Activities Weekly Tutoring — study hour and classes 9 : 00 a.m. — 12 : 00 p.m. Saturdays . Weekly Character/self esteem building sessions ; community activities; conflict resolution. As needed — ongoing Life Skills sessions ; rap sessions Each nine weeks Academic improvement (progress reports and report cards) Weekly — ongoing Reducing negative behaviors — through rap sessions, field trips, seminars, training and mentoring Weekly Recreational activities and drills Weekly Institute counseling and referrals i 13 Type the Organization and Program Name • Meals ( # meals x clients x 5days x 50 wks) • Snacks 43 Administrative Costs Admin . Cost (% of total budget) 44 Audit Expense 1500 .00 1500.00 1 , 500. 00 Independent Audit Review 45 Specific Assistance to Individuals • Medical assistance • Meals/Food • Rent Assistance • Other 46 Other/Miscellaneous • Background check/drug test • Other 47 Other/Contract Sub-contract for program services 48 TOTAL EXPENSES $58 ,286 . 71 $ 58 ,286 . 71 $ 580286. 71 c 5/172005 B•1 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 18t 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 - Organization : St. Peter ' s Human Services, Inc . Program : Boy ' s Development and Training Institute Founder : Children ' s Service Council . H. PROJECTIONS FOR UNDUPLICATED CLIENTS Number of Unduplicated Clients by Location :,Last I+yscal Years Current Fiscal Year Location Actual 2004 3/2004,5Budget 2004/05 ` Projections !06 .. . . K Unduplicated Clients Unduplicated Clients Unduplicated Clients N. Indian River County 40 45 50 S . Indian River County - - - Indian River Co. Total 40 45 50 Greater Stuart - - - Hobe Sound - - - Indiantown - - - Jensen Beach - - Palm City - - Martin County Total - - Fort Pierce Port Saint Lucie - - - St. Lucie Co. Total - - - Other Locations TOTAL SERVED 40 45 50 Inivd ` Gro p Individual Group 1111 rrri 0 to 4 - (Pre-school) - - - - - - 5 to 10 - (Elementary) 21 22 24 11 to 14 - (Middle) 22 23 26 15 to 18 - (High School) - - - - - - Total Children - 43 - 45 - 50 19 to 59 - (Adults) - - - - - - 60 + ( Seniors) - - - - - Total Adults - - - - - TOTAL SERVED - 43 - 45 - 50 14 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 Specific Budget Forms. AGENCY/PROGRAM NAME : Boy's Development & Training Institute FUNDER : Children 's Services Council CAUTION : Do not enter any figures where a cell is colored in dark blue - Formulas and/or links are in place. Gray areas should be used for calculations and to write information only. OKAY AREAS fOR REVENUES Proposed Total Program Funder Specific TotalAgency Budget Budget Budget 1 Children's Services Council-St. Lucie 2 Children 's Services Council-Martin 3 Advisory Committee-Indian River 581286. 71 58,286.71 58,286. 71 4 United Way-St Lucie County 5 United Wa -Martin County 6 United Wa -Indian River County 7 Department of Children $ Families 8 County Funds 9 Contributions-Cash 10 Pro ram Fees 11 Fund Raising Events-Net 12 Sales to Public - Net 13 Membership Dues 14 Investment Income 15 Miscellaneous 16 Legacies & Bequests 17 Funds from Other Sources 18 Reserve Funds Used for Operating 19 In-Kind Donations (Not included in total) 20 TOTAL REVENUES (doesn't include line 19) $ 58 , 286. 71 $ 582286 . 71 $58 ,286 . 71 B D EXPENDITURES GRAY AREAS FOR Proposed Total Program Funder S ecl!fic AGENCY USE ONLY p Total agency :: s" ca< „wa Budget Budget '` ' " 'Budde 21 Salaries - (must complete chart on next page) 36, 872 . 00 36, 872. 00 36,872. 00 Salary . 22 FICA - Total salaries x 0 . 0765 7.65% 21820.71 2, 820. 71 21820.71 e firemen - Annual pension tor qua I le 23 staff 0. 00 Life/Heal - e Ica en a o -term 24 Disab. Workers Compensation - # employees x 0. 00 25 rate Honda Unemployment - prole e 0 . 00 26 employees x $7, 000 x UCT-6 rate 0 . 00 SALARIES A _ e = v ti POSITION UST/NG Gross Annua! portoir of Salary ori Proposed ' c % of Gross Arrnua! Sa/erygrom Funder Speclfle Budget x Salary Position Title / Total Hrs/wk (Agency); udl�At . - 5/1721x15 B-1 EXHIBIT C STANDARD TERMS FOR GRANT CONTRACT 1 . Notices . Any notice , request , demand , consent , approval , or other communication required or permitted by this Contract shall be given , or made in writing , by any of the following methods : facsimile transmission ; hand delivery to the other party; delivery by commercial overnight courier service ; or mailed by registered or certified mail (postage prepaid ) , return receipt requested at the addresses of the parties shown below: County: Joyce Johnston-Carlson , Director Indian River County Human Services 1840 25th Street Vero Beach , Florida 32960-3365 Recipient : St . Peters Academy 425038 th Avenue Vero Beach , Florida 32967 Pastor Andrew Jefferson , 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 - AaORV CERTIFICATE OF LIABILITY INSURANCE TOp E ��rt ; � „ � , � f PRODUCER THIS�CF.RTfFtCATE IS ISSUCL) AS A MAUER OF INFORMATION ONLY ANIS CONFERS NO RICHTS UPON THE CERTIFICATE Ha LCher InsurNncc , Inc . HOLDER . THiS C, ERTIFICATC DOES NOT AMEND, EX I-END OR P . O . r1ox 5d068a I ALTLR THE COVERAGE AFFORUL= D BY THE POLICIES BELOW. Orlando EZ 32854 - 0689 Phone : 407 - 841w2586 53x : 407 - 881 - 7 SAA INSURERS AFFORDING COVERAGE NAIC4 . . ._ _�__�. ... INSURED IN -. URER A rail _ �•iw r a i •. + uran - e _ - a _ ._ _ _. St . PAters Academy Charter Seh St . Peters Human serva- cas , Inc, 4250 36th Avent1O f; suNFRc Vero Beach FL .32967 - 1711 i-- -- - -- - — � -- - IN60RER c . I COVERAGES _ _ - -- i HA i't)1 .,:1[ ;i :YF lNJ::R�iit E Lm ! zG -0,1V ; 'LAVC '?[ ry .'Er' TO ru _ .i .',t i!{G:C NAVA. � - jii JE FC2 THE PCL ICY�' F[�' 1('Jt 'NQIi,nTtD iJC`TJJ ITH ;;•'.1N71N .: �_� ANY REQUIREMENT TERM OR : ONCITfGfJ Y' AN •:O N I ?r I "n n t'r :+ 1'IrH Rk .0C . T TD 't, lJC I tHIS tF frC UR MAY PER'. AIN, THE INbURANCE AFFORDED OY THE Pull(, t_;a Dt=w I21L.Ff1 it! h }- ,ti : :nU�. 16 . T TC? . y ..l kE '. iP61 , ;.r: LI , , I/ .. ,i : D G ':i Nl ' IT t_ !•!3 _ ( ' •U :: FI I•Ct. IC;r 'j 'a�GRFGATF LtP IV1 yHC, 6N hihi ; +A .rC IAR -- . - AD1J�. . . .. ._. . . .. _, >SiSCTCY EFFFEfi�J€ ?84t:GY axFtiPEiT10N t LTR 1NSRO TYVE OF INSURANCE POULY NUMEER OATS (MM/UD(YYl - DA, iMM/OO/YY} UM T : GENERAL LIABILITY- A x rX- ! cc41Me4CL1tn= eFa� uas' I . rY I PNPK1. 3721 ]_ 09 / 17 / 05 1 09 / 17 / 06 L eau t_ 3 _'I =, clronrPI � ; lUUC} 00 _ I- 'tit--._ . �G . {i a � y 'nt- -10 1 r r i r Ai t U � rF , _ r , L nVf NILNV 1000000 0 3 / 17 / Ub —= PO rGJ'l :.f:C.nE.r•A. tE LtlN' ( r>•t• :.. • . t � 1 = -1? .. t 'ti ;)1- J T : ,_ , ' tP iP .r I2000000 I PCLiCY I i jffT 1 6UD AUTOMORtLL LtACILiTY i �' :;,+API N2O ;It-! -:}t i=. :Plf i Ed :K.0 Itlf 11f, I ALL '„IVvFICu Ai1Ta;, ! f'iiI II ! jrT/ mei ¢m GR FC iLrD T01, j C H:REo auros j �crx ! I ula AUTO.- } ` ( Far dCQtlanlj > nt T 1 :. t PRCPrRTY -"AMAC O GARAGF LIABILITY AUTO ONL Y - FA ACC ( EI � —� �— f .x A' .i ANY ;UTO f j �, I HE + IHAr., AUTO JNL Y A 6 £ i CXCG=UMBRELLA LIABILITY rl R , h( C 11000000 I e� x LkDAStIAOe. I ?RE 8041459 0 � / 1 ? I05 09J77 / 06 A� :RCf1aTF ---- 5100 } 0 ) 0 ... _ . .,K I •13, 'I RETENTION $ 10000 WORKERS COMPENSATIUN ANO ,-._ - EMPLOYERS* LIAOILnvyTr 9306885 ' 09 / 17 / U5 09 / 17 / 06 tL = cH � Iu' I T ; 1c000U ANY PROPRIETOR(PAR f NEFiEf ECU i wtn �- j GFFI�F_R(ME EIEP. EXCLUOPLV .6.,SC. Er tat - f ri : 10 I� U (� 0 it. yes . desenbeurAler -A55 - Pf„ t, ICY LIVIT $ 500000 PCCIAL PRO�iISF�NS b6fUw - OTHER ! I I I j I OESCHWTION Of OPERATIONb t LOCATIONS t VV IrICLES 1 LXCL U.5iONS ADOEU CIY CN DORSEMENT +PliCtAL WROV:Skl: : Certificate holder is included as adda t. onral i. nnured regarding general .Liability . LIzaY>ylity it .Lsmitad tc .i. fJaS or dxmay arlsing Cut of negligent acts of the insured . * Except as required by Florida Statute . CERTIFICATE HOLDER CANCELLATION F•� SWOUL0 ANY 01% .1,HE ACSOVC 0[5CRfflLD FOLICtrf, tIE CANCEiLfn 13FFORE TIIE C)(PIRkTION zNnExzv OATS THEREOF, TWE ISSUING INSURER WILL ENDEAVOR TO MAIL 3 �} f DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TU THE LFItT, BUT V-A&URC= TO nO 50 30WL. Indian River Cdun ty , Florida IMPOSE NO 05LK3ATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITR AC�F_NTN OW 1840 25th Strrlat Vero Beach FL 32 `360 - 3365 Rev!tE4ENTAnvCs. _ AUT r ACORD 25 ( 20011-46) r.F5 ACORD CORPORATION 1988 TOTAL F , 02 OCT 17 , 2005 09 : 57 407 841 2688 Page 2 Type the Organization and Program Name Program Director/Administrator - 10 hrs 7 , 800. 00 71800. 00 79800.00 100 . 00% Propram Operations Manager - 25 hrs 15 , 500. 00 15, 500. 00 15 , 500. 00 100 . 00% Institute Prevention Coordinator - 12 hrs 91360 . 00 91360. 00 9, 360. 00 100 . 00% (2 ) Institute Trainers/Teachers - 6 hrs 4 , 212 . 00 41212 . 00 41212 . 00 100. 00% #DIV/0 ! #DIV/0 ! #DIV/0 ! #DIV/0 ! #DIV/0 ! #DIV/0 ! #DIV/o ! #DIV/0 ! #DIV/0 ! #DIV/0 ! #DIV/0 ! #DIV/0 ! #DIV/0 ! #DIV/0 ! #DIV/0 ! #DIV/0 ! Remaining positions throughout the agency Total Salaries 1 $36 , 872 . 001 $360872 . 00 $360872. 00 100. 00% FRINGE BENEFITS DETAIL a (Funder Specific Budget Funder Is Workers Unemp D e f c Pension loyme Total Fringes funder Column C only, from line 22 to 27) Specific FICA 7,65% A x %1 Health Ins, Position Title ! Total HrsAvk ` Budget Compens. nt Compens. Specific Program Director/Administrator - 10 hrs 7, 800 . 00 596. 70 596.70 Propram Operations Manager - 25 hrs 15 . 500 . 00 11185. 75 19185. 75 Institute Prevention Coordinator - 12 hrs 9 , 360 . 00 716 . 04 716.04 (2) Institute Trainers/Teachers - 6 hrs 4 , 212 . 00 322 .22 322 .22 0 0 . 00 0. 00 0 .00 0 0 . 00 0 . 00 0 . 00 0 0 . 00 0 . 00 0. 00 0 0 . 00 0 . 00 0 . 00 0 0 . 00 0 . 00 0. 00 0 0 . 00 0. 00 0 . 00 0 0 . 00 0 . 00 0 . 00 0 0 . 00 0. 00 0. 00 0 0 . 00 0 . 00 0. 00 0 0. 00 0 . 00 - 0 . 00 0 0. 00 0 . 00 0 . 00 0 0 . 00 0 .00 10 . 00 0 0 . 00 0 . 00 0 . 00 0 0 . 00 0 . 00 0. 00 0 0 . 00 0 .00 0. 00 0 0 . 001 0. 00 0. 00 Total Funder Request Fringe Benefits 1 $ 36P872. 001 $2 , 820. 71 $0. 001 $0. 001 $ 0. 001 $0 . 00 $2, 820. 71 A _ B C ID EXPENDITURES ORAYAREAS FOR Proposed Total Program Funder Specific Total Agency AGENCY SHOW MTTNL TO - Budget _ � Budget Budget 27 Travel-Daily # of Staff x average # of miles/wk x 50 wks x $ = Estimated Daily Travel/Mileage Reimb . 28 Travel/conferences/Training 5/17/2005 - 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 Office supplies ( monthly average x 12 months = estimated cost of office supplies based on present history. 30 Telephone # 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 • Quarterly Mailing of Newsletter • Special events , etc. • Bulk mailings - appeals 32 Utilities • Electricity ($ x 12 months) • Water/Sewer ($ x 12 months) • Garbage ($ x 12 months) 33 Occupancy (Building & Grounds ) • Mortgage/Rent ($ x 12 months ) • Janitorial ($ x 12 months) • Grounds Maint. ( $ x 12 months) • Real Estate Taxes 34 Printing & Publications Quarterly Newsletter ($ x 4) Letterheads , Envelopes , etc. Fundraising materials Other 35 Subscription/Dues/Memberships • Membership to National Organization • Dues • Subscriptions to Newspapers/magazines , etc. 36 Insurance • Directors/Officers Liab . • Commercial/General Insurance • Bond Ins. • Auto Insurance 37 Equipment: Rental & Maintenance Copier lease ($ x 12 months) c Meter lease ($ x 12 months) Copier Maintenance ($ x 12 months) Computer Maintenance ( $ x 12 months) Other 38 Advertising 500. 00 500.00 500. 00 • Newspaper ads • Fundraising ads/promotions • Other (vacancies) 39 Equipment Purchases : Capital Expense Computer/monitor (# x $) Laser Printer 40 Professional Fees ( Legal, Consulting ) • Legal advice ( estimated #hrs x $) • Consultant fees • Other 41 Books/Educational Materials 500 . 00 500. 00 500 . 00 • Books/videos • Materials ($ x staff) 42 Food & Nutrition 16,094. 00 16, 094. 00 16,094. 00 5n 7r2005 s-� Nov t) 4 1.) %.i : ? yY CERTIFICATE OF INSURANCE SUCH INSURANCE AS KiiS -r _CI-S fHE ! NTEREST OF THE CERTIFICATE HOLDER WILL NOT .BE CANCELED OR OTHERWISE ENI WITHOUT atvtNG 10 DAYS FRIAR WRITTEN NOTICE TO THE CERTIf3CATE HOLDEP, NAMED BELOW, BUT IN NO THIS CERTIFICATE BE VALID MORE THAN 30 DAYS FROM THE DATE WRITTEN. THIS CERTIFICATE OF INSURANCE ANGE THE COVERAGE PROVIDED BY ANY POLICY DESCRIBED BELO . t: fa STATE FARM NVJ JAL AUTCM081LE INSUPWNCE COMPANY of Btoomigion. ! Ilinois . or 3T.ATE FAR .0 F! RE AND CASUA_T'e COMPANY of 6!oo-dnaton , 111incis hers .overage in torte -or :he fo.iowing Nameu InSLred as shown below : riarnen Invural St , Peters Missionary Baptist Ch ,jrch Inc. — Ad Tress of t•lamed Inst. rea 4250 38 `"` A•✓= . Vero Beech . FL 32567 NUMB 8102332C0959f f 127 0534403. 59A u?3 5141 .827-59 1340 2E32•Q09 59 EFFEC NE GATE 0= + 1010510405!091'05 0r09104-04109f05 1994 POOGE 6350 VAN i 1961 INTEL BUS 1 1996 FORD ' 994 00OGE DESCRIPTGN OF EiiO 'dAN 8350 VAN VEHIC _- _ta81Ll`Y CO`JRRAGe -�yYa; IANC O'fES ❑ NC - - YES ] NO — EYES ]N ^ - -10 T S OF LiMiLM! a . Bodily lnrury t i"cn Person —_ - •--- a. ewiiy lnjcr e I ! Each Acddent b. Prcpe" Damage I I c. Bodily n. ury -- Froaerty Damage 51 ,000 ,000 . 00 i $1 ,006, 000 .00 1 $ 1 ,0000000 . 00 a1 ,flCfl , DOD .CO Single Licht Esch _ - - ---- - -- --_ _ i Acc.dnt _ � N_O lYES �YCSiYStCA GtirAGc ]NO ZYES - - i;UvEib4GE5 5250 00 Deductitl0 $21C .0f7 Deductible i $250 00 Dep.4ucvtmlE $ 2500 0 Ded t0ble a. Comprehensive — YES 0P4 -[RYES ONO olYSS ONO AYES ❑ Nt7 b. C�tlsion S O . 00 OeduclibiA X00 D&Juctible ( 500 . Or` Deductible 500 -00 Deductible :f,APLOYMS 4 N •OWNERSHIP ❑ Y .5 UO ❑YES ENC I ] YES Z.. t,4o ❑YEs gNO COVERAGE _ HIRED CAR COVEFL4GE l iY £ a K IvQatt_ YES ," NO YES NO - _ 0y =3LN0, I-LAt ) Agem 2733 11104/04 Igr al.Ir9 of A�Ii*,orized Repr _ntatfve , y itle Agr nt 's Cade Number Date — Name and Address of Certificate Hofer- Name and Address of Agent David E . Fledges , Ste?e Farm insurance Agency lildian River County 2601 20`" Street Suite S Vero Beach , FL 32960 Check if a permanent Certificate ;;f insurance for liability .overage is needed : r"7: eck if the Certificate Huir ei should be acded as ai Additional Insured: ] Reria-Ks . 14.9 - • .B � F. 6.. J-}t n,vra] fn � : .;,. LL�fi COMMERCE AND INDUSTRY INSURANCE COMPANY 76119 - 0000 WC - 930 - 64 - 45 15172 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 013 - 82 - 0905 - 00 • . NEW YORK ST . PETER ' S ACADEMY CHARTER SCHOOL 4250 38TH AVE � � Member Companies of VERO BEACH , FL 32697 - 0000 American International Group EXECUTIVE OFFICES : 70 PINE STREET , NEW YORK, N . Y. 10270 SEE NAME AND ADDRESS SCHEDULE - WC990610 I . o # 0 104 10 FL UI # : Hatcher Insurance Inc . . . PO Box 540689 WORKERS COMPENSATION AND EMPLOYERS Orlando , FL 32854 LIABILITY POLICY INFORMATION PAGE INSURED IS PREVIOUS POLICY NUMBER CORPORATION RENEWAL 007754294 OTHER WORKPLACES NOT SHOWN ABOVE : SEE NAME AND ADDRESS SCHEDULE - WC 0610 ITEM 2 POLICY PERIOD 12:01 A. M. standard time at the insured 's mailing address FROM 09 / 17 / 05 TO 09 / 17 / 06 ITEM 3 A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states listed here : FL B. Employers Liability Insurance: Part Two of the policy applies to the work in each state listed in item 3 .A . The limits of our liability under Part Two are: Bodily Injury by Accident $ 100 , 000 each accident Bodily Injury by Disease $ 500 , 000 policy limit Bodily Injury by Disease $ 100 , 000 each employee C. Other States Insurance: Part Three of the policy applies to the states , if any, listed here: AK AL AR AZ CO CT DC DE GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC NE NH NJ NM NV NY OK OR PA RI SC SD TN TX UT VA VT WI ITEM 4 The premium for this policy will be determined by our Manuals of Rules , Classifications , Rates and Rating Plans . All information required below is subject to verification and change by audit. Estimated Total Rate Per Estimated Classifications Code Number Remuneration $ 100 OF Re- Premium Annual 11 3 Year muneration Annual 3 Year SEE EXTENSION OF INFORMATION PAGE - WC7754 EXPENSE CONSTANT ( EXCEPT WHERE APPLICABLE BY STATE) $ 200 FL MINIMUM PREMIUM $ 1 9000 FL TOTAL ESTIMATED PREMIUM $ 9Y656 If indicated below, interim adjustments of premium shall be made : Semi -Annually Quarterly Monthly DEPOSIT PREMIUM ENDORSEMENTS ( FORM NUMBER ) SEE ATTACHED FORM SCHEDULE - WC990612 07 / 25 / 05 PARSIPPANY 82 Issue Date Issuing Office Authorized Representative wC 00 00 01 39967 INSURED ' S COPY Type the Organization and Program Name • Meals ( # meals x clients x 5days x 50 wks) • Snacks 43 Administrative Costs Admin . Cost (% of total budget) 44 Audit Expense 1500 .00 1500.00 1 , 500. 00 Independent Audit Review 45 Specific Assistance to Individuals • Medical assistance • Meals/Food • Rent Assistance • Other 46 Other/Miscellaneous • Background check/drug test • Other 47 Other/Contract Sub-contract for program services 48 TOTAL EXPENSES $58 ,286 . 71 $ 58 ,286 . 71 $ 580286. 71 c 5/172005 B•1 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 18t 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 - MAL REVENUE S 'cRV IC'c DEPARTMENT OF TME TREASURY �: D1sTRICT DIRECTOR � . BOX 2508 INNATI , OH 45241 ` Employer Identification Number : Date : 31 - 1480633 W. Ir DIN : 17053042275008 ST PETERS HUMAN SERVICES Contact Person : INCORPORATED D . A . DOWNING CJI REV ANDREW JEFFERSON Contact Telephone Number : 4250 38TH AVE A ( 513 ) 241 - 5199 GIFFORD , FL 32967 Accounting Period Ending : August 31 Fare 990 Required : Yes Addendum Applies : Yes Dear Applicant : Based on information supplied , and assuming your operations will be as stated in your application for recognition of exemption , we have determined you are exempt from federal income tax under section 501 ( a ) of the Internal Revenue Code as an organization described in section 501 ( c ) ( 'J ) • We have further determined that you are not a private foundation within the meaning of section 509 ( x ) of the Code , because you are an organization described in sections 509 ( 4 ) ( 1 ) and 170 ( b ) ( 1 ) ( A ) ( ii ) . If your sources of support , or your purposes , character , or method of operation change , please let us know so we can consider the effect of the change an your exempt status and foundation status . In the case of an amend - ment to your organizational document or bylaws , please send us. a- copy of the amended document or bylaws . Also , you should inform us of all changes in your name or address . As of "January 1 , 1984 , you are liable far taxes under the Federal Insurance Contributions Act ( social security taxes ) on - remuneration of 6100 or more you pay to each of your employees during a calendar year. You are not liable for the tax imposed under the Federal Unemployment Tax Act ( FUTA ) . Since you are not a private foundation , you are not subject to the excise taxes under Chapter 42 of the Code . However , if you are involved in an excess benefit transaction , that transaction might be subject to the excise taxes of section 4958 . Additionally , you are not automatically exempt from other federal excise taxes _ If you have any questions about excise , employment , or other federal taxes , please contact your key district office . Grantors and contributors may rely on this determination unless the Internal Revenue Service publishes notice to the contrary . However , if you lose your section 509 ( a ) ( 1 ) status , a grantor or contributor may not rely on this determination if he or she was in part responsible for , or was aware of , the act or failure to act , or the substantial or material change- on the part of the organization that resulted in your loss of such status , or if he or she acquired knowledge that the Internal Revenue Service had given notice that Letter 947 ( DO / CG ) r NAI, REVENUE SERVICL OEPARTMENr OF THE TREASURY DI � � LCT DIRECTOR BOX 2508 iNwrI , OH 43201 Employer Identification Umber : r Date : 31 - 1480623 DIN : 17053042275008 S7 PETERS HUMAN SERVICcS Contact Person : INCORPIORATED D . A . DONNING C/ O REV AtQREU JEFFERSON Contact Telephone Number : 4250 38TH AVE A ( 511 ) 241 - 5199 GIFFORD , FL 32967 Accounting Period Ending : Auqus t 3 '._ Fara 990 Required : Yes Addendum Applies : Yes Dear Applicant : Based on information supplied , and assuming your operations will be as stated in your application for recognition of exemption , we have determined you are exempt from federal income tax under section 501 ( a ) of the Internal Revenue Code as an organization described in section 501 ( c ) ( 'J ) . We have further determined that you are not a private foundation within the weaninq of section 509 ( x ) of the Cade , because you are an organization described in sections 509 ( a ) ( 1 ) and 170 ( b ) ( 1 ) ( A ) ( ii ) . If your sources of support , or your purposes , character , or method of operation change , please Let us know so we cin consider the effect of the change on your exempt status and foundation status . In• the case of an amend - ment to your organizational document or bylaws , please send us• a• copy of the amended document or bylaws . Also , you should inform us of all changes in your name or address . ram 'Sa : nary 1 , yG ;: are Liable far t:. aes carder thaw cem+ P +- al insurance Contributions Act ( social security taxes ) on . reauner'action cit X100 or acre you pay to each of your employees during a calendar year. You art not liable for the tax imposed under the Federal Unemployment Tax Act ( FUTA ) . Since you are not a private foundation , you are not subject to the excise taxes under Chapter 42 of the Code . However , it you are involved in an excess benefit transaction , that transaction might be subject to the excise taxes of section 4958 . Additionally , you are not automatically exempt from other federal excise taxes . If you have any questions about excise , employment , or other federal taxes , please contact your key district office . Grantors and contributors may rely on this determination unless the Internal Revenue Service publishes notice to the contrary . However , if You lose your section 509 ( a ) ( 1 ) status , a grantor or contributor may not rely on this determination if he or she was in part responsible for , or was aware of , the act or failure to act , or the substantial or material change on the part of the organization that resulted in your loss of such status , or Lf he or' she acquired knowledge that the Internal Revenue Service had given notice that Letter 947 ( DO/ CS ) EXHIBIT C STANDARD TERMS FOR GRANT CONTRACT 1 . Notices . Any notice , request , demand , consent , approval , or other communication required or permitted by this Contract shall be given , or made in writing , by any of the following methods : facsimile transmission ; hand delivery to the other party; delivery by commercial overnight courier service ; or mailed by registered or certified mail (postage prepaid ) , return receipt requested at the addresses of the parties shown below: County: Joyce Johnston-Carlson , Director Indian River County Human Services 1840 25th Street Vero Beach , Florida 32960-3365 Recipient : St . Peters Academy 425038 th Avenue Vero Beach , Florida 32967 Pastor Andrew Jefferson , 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 - . •, , l. l I t` 4S7 PETERS HUMAN SERVICES you would no longer be classified as a section 509 ( a ) ( 1 ) organization . J Donors may deduct contributions to you as provided in section 170 of the Code . Bequests , legacies , devises , transfers , or gifts to you or for your use are deductible for federal estate and gift tax purposes if they meet the applicable provisions of Code sections 2055 , 2106 , and 2522 . Contribution deductions are allowable to donors only to the extent that their contributions are gifts , with no consideration received . Ticket pur - chases and similar payments in conjunction with fundraisinq events may not necessarily qualify as deductible contributions , depending on the cirnl . -. stances _ See Revenue Ruling 67 - 246 , published in Cumulative Bulletin 1967 - 2 , on page 104 , which sets forth guidelines regardinq the deductibility , as chari - table contributions , of payments made by taxpayers for admission to or other participation in fundraisinq activities for charity . In the heading of this letter see have indicated whether you must file Fare 990 , Return of Organization Exempt From Income Tax . If Yes is indicated , you are required to file Form 990 only if your gross receipts each year are normally more than $25 , 000 . However , if you receive a Form 990 package in the mail , please file the return even if you do not exceed the gross receipts test . If you are rot required to file , simply attach the label provided , check the box in the heading to indicate that your annual gross receipts are normally 525 , 000 or less , and sign the return . If a return is required , it - must be filed by the 15th day of the fifth month after the end of your annual . accountinq period . A penalty of $ 20 a day is charged when a return is filed late , unless there is reasonable cause for the delay . However , the maximum penalty charged cannot exceed $ 10 , 000 or 5 percent of your gross receipts for the year , whichever is less _ For organizations with gross receipts exceeding $ 1 , 000 , 000 in any year , the penalty is $ 100 per day per return , unless there is reasonable cause far the delay . The maximum penalty for an organization with gross receipts exceeding 5110001000 shall not exceed $ 50 , 000 . This penalty may also be charged if a return is not complete , so be sure your return is complete before you file it . You are required to make your annual return available for public inspection for three years after the return is due . You are also required to make available a copy of your exemption application , any supporting documents , and this exemption letter . Failure to make these documents available for public inspection may subject you to a penalty of S20 per day for each day there is a failure to comply ( up to a maximum of 610 , 000 in the case of an annual return ) . You are not required to file federal income tax returns unless you are subject to the tax on unrelated business income under section 511 of the Code . If you are subject to this tax , you must file an income tax return on Form 990 - T , Exempt Organization Business Inco ■e Tax Return . In this letter we are not determining whether any of your present or proposed activities are unre- lated trade or business as defined in section 513 of the Code . Letter 947 ( DO / CG ) - 3 - S7 PETERS HUMAN SERVICES You need an employer identification number even if you have no employees . If an employer identification number was not entered on your application , a number will be assigned to you and you will be advised of it . Please use that number on all returns you file and in all correspondence with the Internal Revenue Service . This determination is based on evidence that your funds are dedicated to the purposes listed in section 501 ( c ) ( 3 ) of the Code . io assure your continued exemption , you should keep records to show that funds are expended only for those purposes . If you distribute funds to other organizations , your records should show whether they are exempt under section 501 ( c ) ( 3 ) . In cases where the recipient organization is not exempt under section 501 ( c ) ( 3 ) , there should be evidence that the funds will remain dedicated to the required purposes and that they will be used for those purposes by the recipient . If distributions are made to individuals , case histories regarding the recipients should be kept showing names , addresses , purposes of awards , manner of selection , relationship ( if any ) to members , officers , trustees or donors of funds to you , so that any and all distributions made to individuals can be substantiated upon request by the Internal Revenue Service . ( Revenue Ruling 56 -304 , C . B . 1956 - 2 , page 346 . ) If we have indicated in the heading of this letter that an addendum applies , the enclosed addendum is an integral part of this letter . Because this letter could help resolve any questions about your exempt status and foundation status , you should keep .it in your , permanent records . If you have any questions , please contact the person whose name and telephone number are shown in the headinq of this letter . Sincerely yours , District Director v Enclosure ( s ) : Addendum • Letter 947 ( DO / CG ) AaORV CERTIFICATE OF LIABILITY INSURANCE TOp E ��rt ; � „ � , � f PRODUCER THIS�CF.RTfFtCATE IS ISSUCL) AS A MAUER OF INFORMATION ONLY ANIS CONFERS NO RICHTS UPON THE CERTIFICATE Ha LCher InsurNncc , Inc . HOLDER . THiS C, ERTIFICATC DOES NOT AMEND, EX I-END OR P . O . r1ox 5d068a I ALTLR THE COVERAGE AFFORUL= D BY THE POLICIES BELOW. Orlando EZ 32854 - 0689 Phone : 407 - 841w2586 53x : 407 - 881 - 7 SAA INSURERS AFFORDING COVERAGE NAIC4 . . ._ _�__�. ... INSURED IN -. URER A rail _ �•iw r a i •. + uran - e _ - a _ ._ _ _. St . PAters Academy Charter Seh St . Peters Human serva- cas , Inc, 4250 36th Avent1O f; suNFRc Vero Beach FL .32967 - 1711 i-- -- - -- - — � -- - IN60RER c . I COVERAGES _ _ - -- i HA i't)1 .,:1[ ;i :YF lNJ::R�iit E Lm ! zG -0,1V ; 'LAVC '?[ ry .'Er' TO ru _ .i .',t i!{G:C NAVA. � - jii JE FC2 THE PCL ICY�' F[�' 1('Jt 'NQIi,nTtD iJC`TJJ ITH ;;•'.1N71N .: �_� ANY REQUIREMENT TERM OR : ONCITfGfJ Y' AN •:O N I ?r I "n n t'r :+ 1'IrH Rk .0C . T TD 't, lJC I tHIS tF frC UR MAY PER'. AIN, THE INbURANCE AFFORDED OY THE Pull(, t_;a Dt=w I21L.Ff1 it! h }- ,ti : :nU�. 16 . T TC? . y ..l kE '. iP61 , ;.r: LI , , I/ .. ,i : D G ':i Nl ' IT t_ !•!3 _ ( ' •U :: FI I•Ct. IC;r 'j 'a�GRFGATF LtP IV1 yHC, 6N hihi ; +A .rC IAR -- . - AD1J�. . . .. ._. . . .. _, >SiSCTCY EFFFEfi�J€ ?84t:GY axFtiPEiT10N t LTR 1NSRO TYVE OF INSURANCE POULY NUMEER OATS (MM/UD(YYl - DA, iMM/OO/YY} UM T : GENERAL LIABILITY- A x rX- ! cc41Me4CL1tn= eFa� uas' I . rY I PNPK1. 3721 ]_ 09 / 17 / 05 1 09 / 17 / 06 L eau t_ 3 _'I =, clronrPI � ; lUUC} 00 _ I- 'tit--._ . �G . {i a � y 'nt- -10 1 r r i r Ai t U � rF , _ r , L nVf NILNV 1000000 0 3 / 17 / Ub —= PO rGJ'l :.f:C.nE.r•A. tE LtlN' ( r>•t• :.. • . t � 1 = -1? .. t 'ti ;)1- J T : ,_ , ' tP iP .r I2000000 I PCLiCY I i jffT 1 6UD AUTOMORtLL LtACILiTY i �' :;,+API N2O ;It-! -:}t i=. :Plf i Ed :K.0 Itlf 11f, I ALL '„IVvFICu Ai1Ta;, ! f'iiI II ! jrT/ mei ¢m GR FC iLrD T01, j C H:REo auros j �crx ! I ula AUTO.- } ` ( Far dCQtlanlj > nt T 1 :. t PRCPrRTY -"AMAC O GARAGF LIABILITY AUTO ONL Y - FA ACC ( EI � —� �— f .x A' .i ANY ;UTO f j �, I HE + IHAr., AUTO JNL Y A 6 £ i CXCG=UMBRELLA LIABILITY rl R , h( C 11000000 I e� x LkDAStIAOe. I ?RE 8041459 0 � / 1 ? I05 09J77 / 06 A� :RCf1aTF ---- 5100 } 0 ) 0 ... _ . .,K I •13, 'I RETENTION $ 10000 WORKERS COMPENSATIUN ANO ,-._ - EMPLOYERS* LIAOILnvyTr 9306885 ' 09 / 17 / U5 09 / 17 / 06 tL = cH � Iu' I T ; 1c000U ANY PROPRIETOR(PAR f NEFiEf ECU i wtn �- j GFFI�F_R(ME EIEP. EXCLUOPLV .6.,SC. Er tat - f ri : 10 I� U (� 0 it. yes . desenbeurAler -A55 - Pf„ t, ICY LIVIT $ 500000 PCCIAL PRO�iISF�NS b6fUw - OTHER ! I I I j I OESCHWTION Of OPERATIONb t LOCATIONS t VV IrICLES 1 LXCL U.5iONS ADOEU CIY CN DORSEMENT +PliCtAL WROV:Skl: : Certificate holder is included as adda t. onral i. nnured regarding general .Liability . LIzaY>ylity it .Lsmitad tc .i. fJaS or dxmay arlsing Cut of negligent acts of the insured . * Except as required by Florida Statute . CERTIFICATE HOLDER CANCELLATION F•� SWOUL0 ANY 01% .1,HE ACSOVC 0[5CRfflLD FOLICtrf, tIE CANCEiLfn 13FFORE TIIE C)(PIRkTION zNnExzv OATS THEREOF, TWE ISSUING INSURER WILL ENDEAVOR TO MAIL 3 �} f DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TU THE LFItT, BUT V-A&URC= TO nO 50 30WL. Indian River Cdun ty , Florida IMPOSE NO 05LK3ATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITR AC�F_NTN OW 1840 25th Strrlat Vero Beach FL 32 `360 - 3365 Rev!tE4ENTAnvCs. _ AUT r ACORD 25 ( 20011-46) r.F5 ACORD CORPORATION 1988 TOTAL F , 02 OCT 17 , 2005 09 : 57 407 841 2688 Page 2 Nov t) 4 1.) %.i : ? yY CERTIFICATE OF INSURANCE SUCH INSURANCE AS KiiS -r _CI-S fHE ! NTEREST OF THE CERTIFICATE HOLDER WILL NOT .BE CANCELED OR OTHERWISE ENI WITHOUT atvtNG 10 DAYS FRIAR WRITTEN NOTICE TO THE CERTIf3CATE HOLDEP, NAMED BELOW, BUT IN NO THIS CERTIFICATE BE VALID MORE THAN 30 DAYS FROM THE DATE WRITTEN. THIS CERTIFICATE OF INSURANCE ANGE THE COVERAGE PROVIDED BY ANY POLICY DESCRIBED BELO . t: fa STATE FARM NVJ JAL AUTCM081LE INSUPWNCE COMPANY of Btoomigion. ! Ilinois . or 3T.ATE FAR .0 F! RE AND CASUA_T'e COMPANY of 6!oo-dnaton , 111incis hers .overage in torte -or :he fo.iowing Nameu InSLred as shown below : riarnen Invural St , Peters Missionary Baptist Ch ,jrch Inc. — Ad Tress of t•lamed Inst. rea 4250 38 `"` A•✓= . Vero Beech . FL 32567 NUMB 8102332C0959f f 127 0534403. 59A u?3 5141 .827-59 1340 2E32•Q09 59 EFFEC NE GATE 0= + 1010510405!091'05 0r09104-04109f05 1994 POOGE 6350 VAN i 1961 INTEL BUS 1 1996 FORD ' 994 00OGE DESCRIPTGN OF EiiO 'dAN 8350 VAN VEHIC _- _ta81Ll`Y CO`JRRAGe -�yYa; IANC O'fES ❑ NC - - YES ] NO — EYES ]N ^ - -10 T S OF LiMiLM! a . Bodily lnrury t i"cn Person —_ - •--- a. ewiiy lnjcr e I ! Each Acddent b. Prcpe" Damage I I c. Bodily n. ury -- Froaerty Damage 51 ,000 ,000 . 00 i $1 ,006, 000 .00 1 $ 1 ,0000000 . 00 a1 ,flCfl , DOD .CO Single Licht Esch _ - - ---- - -- --_ _ i Acc.dnt _ � N_O lYES �YCSiYStCA GtirAGc ]NO ZYES - - i;UvEib4GE5 5250 00 Deductitl0 $21C .0f7 Deductible i $250 00 Dep.4ucvtmlE $ 2500 0 Ded t0ble a. Comprehensive — YES 0P4 -[RYES ONO olYSS ONO AYES ❑ Nt7 b. C�tlsion S O . 00 OeduclibiA X00 D&Juctible ( 500 . Or` Deductible 500 -00 Deductible :f,APLOYMS 4 N •OWNERSHIP ❑ Y .5 UO ❑YES ENC I ] YES Z.. t,4o ❑YEs gNO COVERAGE _ HIRED CAR COVEFL4GE l iY £ a K IvQatt_ YES ," NO YES NO - _ 0y =3LN0, I-LAt ) Agem 2733 11104/04 Igr al.Ir9 of A�Ii*,orized Repr _ntatfve , y itle Agr nt 's Cade Number Date — Name and Address of Certificate Hofer- Name and Address of Agent David E . Fledges , Ste?e Farm insurance Agency lildian River County 2601 20`" Street Suite S Vero Beach , FL 32960 Check if a permanent Certificate ;;f insurance for liability .overage is needed : r"7: eck if the Certificate Huir ei should be acded as ai Additional Insured: ] Reria-Ks . 14.9 - • .B � F. 6.. J-}t n,vra] fn � : .;,. LL�fi COMMERCE AND INDUSTRY INSURANCE COMPANY 76119 - 0000 WC - 930 - 64 - 45 15172 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 013 - 82 - 0905 - 00 • . NEW YORK ST . PETER ' S ACADEMY CHARTER SCHOOL 4250 38TH AVE � � Member Companies of VERO BEACH , FL 32697 - 0000 American International Group EXECUTIVE OFFICES : 70 PINE STREET , NEW YORK, N . Y. 10270 SEE NAME AND ADDRESS SCHEDULE - WC990610 I . o # 0 104 10 FL UI # : Hatcher Insurance Inc . . . PO Box 540689 WORKERS COMPENSATION AND EMPLOYERS Orlando , FL 32854 LIABILITY POLICY INFORMATION PAGE INSURED IS PREVIOUS POLICY NUMBER CORPORATION RENEWAL 007754294 OTHER WORKPLACES NOT SHOWN ABOVE : SEE NAME AND ADDRESS SCHEDULE - WC 0610 ITEM 2 POLICY PERIOD 12:01 A. M. standard time at the insured 's mailing address FROM 09 / 17 / 05 TO 09 / 17 / 06 ITEM 3 A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states listed here : FL B. Employers Liability Insurance: Part Two of the policy applies to the work in each state listed in item 3 .A . The limits of our liability under Part Two are: Bodily Injury by Accident $ 100 , 000 each accident Bodily Injury by Disease $ 500 , 000 policy limit Bodily Injury by Disease $ 100 , 000 each employee C. Other States Insurance: Part Three of the policy applies to the states , if any, listed here: AK AL AR AZ CO CT DC DE GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC NE NH NJ NM NV NY OK OR PA RI SC SD TN TX UT VA VT WI ITEM 4 The premium for this policy will be determined by our Manuals of Rules , Classifications , Rates and Rating Plans . All information required below is subject to verification and change by audit. Estimated Total Rate Per Estimated Classifications Code Number Remuneration $ 100 OF Re- Premium Annual 11 3 Year muneration Annual 3 Year SEE EXTENSION OF INFORMATION PAGE - WC7754 EXPENSE CONSTANT ( EXCEPT WHERE APPLICABLE BY STATE) $ 200 FL MINIMUM PREMIUM $ 1 9000 FL TOTAL ESTIMATED PREMIUM $ 9Y656 If indicated below, interim adjustments of premium shall be made : Semi -Annually Quarterly Monthly DEPOSIT PREMIUM ENDORSEMENTS ( FORM NUMBER ) SEE ATTACHED FORM SCHEDULE - WC990612 07 / 25 / 05 PARSIPPANY 82 Issue Date Issuing Office Authorized Representative wC 00 00 01 39967 INSURED ' S COPY MAL REVENUE S 'cRV IC'c DEPARTMENT OF TME TREASURY �: D1sTRICT DIRECTOR � . BOX 2508 INNATI , OH 45241 ` Employer Identification Number : Date : 31 - 1480633 W. Ir DIN : 17053042275008 ST PETERS HUMAN SERVICES Contact Person : INCORPORATED D . A . DOWNING CJI REV ANDREW JEFFERSON Contact Telephone Number : 4250 38TH AVE A ( 513 ) 241 - 5199 GIFFORD , FL 32967 Accounting Period Ending : August 31 Fare 990 Required : Yes Addendum Applies : Yes Dear Applicant : Based on information supplied , and assuming your operations will be as stated in your application for recognition of exemption , we have determined you are exempt from federal income tax under section 501 ( a ) of the Internal Revenue Code as an organization described in section 501 ( c ) ( 'J ) • We have further determined that you are not a private foundation within the meaning of section 509 ( x ) of the Code , because you are an organization described in sections 509 ( 4 ) ( 1 ) and 170 ( b ) ( 1 ) ( A ) ( ii ) . If your sources of support , or your purposes , character , or method of operation change , please let us know so we can consider the effect of the change an your exempt status and foundation status . In the case of an amend - ment to your organizational document or bylaws , please send us. a- copy of the amended document or bylaws . Also , you should inform us of all changes in your name or address . As of "January 1 , 1984 , you are liable far taxes under the Federal Insurance Contributions Act ( social security taxes ) on - remuneration of 6100 or more you pay to each of your employees during a calendar year. You are not liable for the tax imposed under the Federal Unemployment Tax Act ( FUTA ) . Since you are not a private foundation , you are not subject to the excise taxes under Chapter 42 of the Code . However , if you are involved in an excess benefit transaction , that transaction might be subject to the excise taxes of section 4958 . Additionally , you are not automatically exempt from other federal excise taxes _ If you have any questions about excise , employment , or other federal taxes , please contact your key district office . Grantors and contributors may rely on this determination unless the Internal Revenue Service publishes notice to the contrary . However , if you lose your section 509 ( a ) ( 1 ) status , a grantor or contributor may not rely on this determination if he or she was in part responsible for , or was aware of , the act or failure to act , or the substantial or material change- on the part of the organization that resulted in your loss of such status , or if he or she acquired knowledge that the Internal Revenue Service had given notice that Letter 947 ( DO / CG ) r NAI, REVENUE SERVICL OEPARTMENr OF THE TREASURY DI � � LCT DIRECTOR BOX 2508 iNwrI , OH 43201 Employer Identification Umber : r Date : 31 - 1480623 DIN : 17053042275008 S7 PETERS HUMAN SERVICcS Contact Person : INCORPIORATED D . A . DONNING C/ O REV AtQREU JEFFERSON Contact Telephone Number : 4250 38TH AVE A ( 511 ) 241 - 5199 GIFFORD , FL 32967 Accounting Period Ending : Auqus t 3 '._ Fara 990 Required : Yes Addendum Applies : Yes Dear Applicant : Based on information supplied , and assuming your operations will be as stated in your application for recognition of exemption , we have determined you are exempt from federal income tax under section 501 ( a ) of the Internal Revenue Code as an organization described in section 501 ( c ) ( 'J ) . We have further determined that you are not a private foundation within the weaninq of section 509 ( x ) of the Cade , because you are an organization described in sections 509 ( a ) ( 1 ) and 170 ( b ) ( 1 ) ( A ) ( ii ) . If your sources of support , or your purposes , character , or method of operation change , please Let us know so we cin consider the effect of the change on your exempt status and foundation status . In• the case of an amend - ment to your organizational document or bylaws , please send us• a• copy of the amended document or bylaws . Also , you should inform us of all changes in your name or address . ram 'Sa : nary 1 , yG ;: are Liable far t:. aes carder thaw cem+ P +- al insurance Contributions Act ( social security taxes ) on . reauner'action cit X100 or acre you pay to each of your employees during a calendar year. You art not liable for the tax imposed under the Federal Unemployment Tax Act ( FUTA ) . Since you are not a private foundation , you are not subject to the excise taxes under Chapter 42 of the Code . However , it you are involved in an excess benefit transaction , that transaction might be subject to the excise taxes of section 4958 . Additionally , you are not automatically exempt from other federal excise taxes . If you have any questions about excise , employment , or other federal taxes , please contact your key district office . Grantors and contributors may rely on this determination unless the Internal Revenue Service publishes notice to the contrary . However , if You lose your section 509 ( a ) ( 1 ) status , a grantor or contributor may not rely on this determination if he or she was in part responsible for , or was aware of , the act or failure to act , or the substantial or material change on the part of the organization that resulted in your loss of such status , or Lf he or' she acquired knowledge that the Internal Revenue Service had given notice that Letter 947 ( DO/ CS ) . •, , l. l I t` 4S7 PETERS HUMAN SERVICES you would no longer be classified as a section 509 ( a ) ( 1 ) organization . J Donors may deduct contributions to you as provided in section 170 of the Code . Bequests , legacies , devises , transfers , or gifts to you or for your use are deductible for federal estate and gift tax purposes if they meet the applicable provisions of Code sections 2055 , 2106 , and 2522 . Contribution deductions are allowable to donors only to the extent that their contributions are gifts , with no consideration received . Ticket pur - chases and similar payments in conjunction with fundraisinq events may not necessarily qualify as deductible contributions , depending on the cirnl . -. stances _ See Revenue Ruling 67 - 246 , published in Cumulative Bulletin 1967 - 2 , on page 104 , which sets forth guidelines regardinq the deductibility , as chari - table contributions , of payments made by taxpayers for admission to or other participation in fundraisinq activities for charity . In the heading of this letter see have indicated whether you must file Fare 990 , Return of Organization Exempt From Income Tax . If Yes is indicated , you are required to file Form 990 only if your gross receipts each year are normally more than $25 , 000 . However , if you receive a Form 990 package in the mail , please file the return even if you do not exceed the gross receipts test . If you are rot required to file , simply attach the label provided , check the box in the heading to indicate that your annual gross receipts are normally 525 , 000 or less , and sign the return . If a return is required , it - must be filed by the 15th day of the fifth month after the end of your annual . accountinq period . A penalty of $ 20 a day is charged when a return is filed late , unless there is reasonable cause for the delay . However , the maximum penalty charged cannot exceed $ 10 , 000 or 5 percent of your gross receipts for the year , whichever is less _ For organizations with gross receipts exceeding $ 1 , 000 , 000 in any year , the penalty is $ 100 per day per return , unless there is reasonable cause far the delay . The maximum penalty for an organization with gross receipts exceeding 5110001000 shall not exceed $ 50 , 000 . This penalty may also be charged if a return is not complete , so be sure your return is complete before you file it . You are required to make your annual return available for public inspection for three years after the return is due . You are also required to make available a copy of your exemption application , any supporting documents , and this exemption letter . Failure to make these documents available for public inspection may subject you to a penalty of S20 per day for each day there is a failure to comply ( up to a maximum of 610 , 000 in the case of an annual return ) . You are not required to file federal income tax returns unless you are subject to the tax on unrelated business income under section 511 of the Code . If you are subject to this tax , you must file an income tax return on Form 990 - T , Exempt Organization Business Inco ■e Tax Return . In this letter we are not determining whether any of your present or proposed activities are unre- lated trade or business as defined in section 513 of the Code . Letter 947 ( DO / CG ) - 3 - S7 PETERS HUMAN SERVICES You need an employer identification number even if you have no employees . If an employer identification number was not entered on your application , a number will be assigned to you and you will be advised of it . Please use that number on all returns you file and in all correspondence with the Internal Revenue Service . This determination is based on evidence that your funds are dedicated to the purposes listed in section 501 ( c ) ( 3 ) of the Code . io assure your continued exemption , you should keep records to show that funds are expended only for those purposes . If you distribute funds to other organizations , your records should show whether they are exempt under section 501 ( c ) ( 3 ) . In cases where the recipient organization is not exempt under section 501 ( c ) ( 3 ) , there should be evidence that the funds will remain dedicated to the required purposes and that they will be used for those purposes by the recipient . If distributions are made to individuals , case histories regarding the recipients should be kept showing names , addresses , purposes of awards , manner of selection , relationship ( if any ) to members , officers , trustees or donors of funds to you , so that any and all distributions made to individuals can be substantiated upon request by the Internal Revenue Service . ( Revenue Ruling 56 -304 , C . B . 1956 - 2 , page 346 . ) If we have indicated in the heading of this letter that an addendum applies , the enclosed addendum is an integral part of this letter . Because this letter could help resolve any questions about your exempt status and foundation status , you should keep .it in your , permanent records . If you have any questions , please contact the person whose name and telephone number are shown in the headinq of this letter . Sincerely yours , District Director v Enclosure ( s ) : Addendum • Letter 947 ( DO / CG )